Medicare $$$ May Fuel PCMH Movement

Published: Jul 9, 2013

By David Pittman, Washington Correspondent, MedPage Today

WASHINGTON -- Medicare has unveiled a new payment plan that will reimburse providers for the care management of patients with multiple, significant chronic conditions starting in 2015.

If approved as proposed, this new payment scheme is likely to provide the dollars necessary to fuel growth of the patient-centered medical home (PCMH) movement.

As outlined in the proposed rule for the 2014 physician fee schedule, Medicare would pay for non-face-to-face services through separate G-codes for establishing a care plan and managing that care over 90-day periods.

To be eligible, physicians must use electronic medical records (EMRs) specially designed to monitor patients' medical and functional status. Additional requirements will be fleshed out later.

"We plan to address policy regarding the practice standards, including PCMH recognition, through separate notice-and-comment rulemaking," according to a Centers for Medicare and Medicaid Services press release.

Late last year CMS added new billing codes for physicians to coordinate a patient's care in the 30 days following a hospital or skilled nursing facility stay.

The proposed rule would also expand and integrate quality reporting programs within Medicare adding 47 individual measures and 3 measure groups to the Physician Quality Reporting System (PQRS). That program pays physicians and group practices bonuses through 2014 for reporting data on quality measures. Starting in 2015, penalties apply to doctors who don't report the measures.

However, Medicare proposed on Monday that physicians and group practices that satisfy the 2014 PQRS reporting incentive will automatically avoid the 2016 penalty.

In regard to its meaningful use program for EMRs, physicians can submit clinical quality measures used for PQRS to meet certain reporting requirements for stage 2 of meaningful use.

"Meaningful use" refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use EMRs in a meaningful way that significantly improves clinical care.

Medicare officials also proposed paying for telehealth visits for urban providers deemed practicing in health professional shortage areas (HPSAs) by the Office of Rural Health Policy.

"We believe this change will more appropriately identify sites within urban (HPSAs) that have rural characteristics and improve access to telehealth services in shortage areas," CMS said in its release.

Finally, the proposed rule further implements the value-based payment modifier which would adjust payments based on the quality and cost of care they furnish and outlines the next phase of the Physician Compare website.

CMS also on Monday issued a proposed rule that would increase hospital outpatient services by 9.5% and ambulatory surgical centers by 3.51% starting next year. The proposed rule also makes greater use of bundled payments by offering seven new categories to pay such claims.

The proposed fee schedule rule will be published in the Federal Register on July 19. CMS will accept comments on the rule until Sept. 6. The final rule will be published on or about Nov. 1.

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