CMS FFS rule change proposal

[FrustratedFamDoc]

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Members don't see this ad.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

I'm sure the fact that it is over 1400 pages long is purely on accident...

Fighting for a Fee Schedule That Works for You, Your Patients

Discussion?

 

[Money Moniker]

That they're doing away with the complexity levels for office visits is terrible for physicians and a goldmine for midlevels. The midlevels will now bill the same for the sore throat as the physician will for the CHF-COPD-CKD trainwreck.

 

[KeikoTanaka]

That they're doing away with the complexity levels for office visits is terrible for physicians and a goldmine for midlevels. The midlevels will now bill the same for the sore throat as the physician will for the CHF-COPD-CKD trainwreck.

That's absolutely ridiculous..... Even if another physician was just diagnosing Strep throat vs the CHF - COPD- CKD it shouldn't be billed the same

 

[KeikoTanaka]

Actually, won't this lead to an increase in salaries for PCPs since levels 2-5 will all be charged the same amount? Now if you see a bunch of level 2 cases you'll still be paid more?

 

[VA Hopeful Dr]

Actually, won't this lead to an increase in salaries for PCPs since levels 2-5 will all be charged the same amount? Now if you see a bunch of level 2 cases you'll still be paid more?

Maybe?

It depends on if your patients will accept every appointment only addressing 1-2 problems. If yes, you'll make money. If no, you'll lose money.

 

[deleted480308]

Actually, won't this lead to an increase in salaries for PCPs since levels 2-5 will all be charged the same amount? Now if you see a bunch of level 2 cases you'll still be paid more?

They sure as hell aren’t trying to pay us more

 

[VA Hopeful Dr]

They sure as hell aren’t trying to pay us more

Its like the Cold War. Every time CMS tries to pay us less, we change how we bill to negate the changes.

Repeat ad nauseum.

 

[FrustratedFamDoc]

Its like the Cold War. Every time CMS tries to pay us less, we change how we bill to negate the changes.

Repeat ad nauseum.

"Decreasing the cost of healthcare" typically doesn't mean they're interested in paying docs more, especially with the alarming number of administrators that continue to be added to the system.

Dealing with mcare/insurance is like dealing with the 3 card man on the side of the street and you need to guess which one is the ace. I recently had BCBS kick back 6 (yes, 6) separate encounters on one patient because "anxiety and depression" is not a covered diagnosis. Only reason why I had to do it that way was our EMR would not let me enter them individually.

 

[deleted87716]

The AAFP opposes the changes as proposed, and has proposed an alternative. See link: https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-2019ProposedMPFS-090618.pdf

The comment period for CMS is still open, so if you want to let them know how you feel, you can. See link: Regulations.gov

 

[deleted87716]

The AAFP opposes the changes as proposed, and has proposed an alternative. See link: https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-2019ProposedMPFS-090618.pdf

The comment period for CMS is still open, so if you want to let them know how you feel, you can. See link: Regulations.gov

If anyone wants to comment, but isn't sure what to say, feel free to copy my response (cut-and-pasted, for the most part, from the AAFP letter):

As a practicing family physician who sees a large number of Medicare patients, I write in response to the proposed rule titled, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program” published by the Centers for Medicare & Medicaid Services (CMS) in the July, 27, 2018, Federal Register.

I share your goals for Medicare reform, but I have serious reservations as to whether the bold reforms included in the 2019 proposed rule can be practically (or at all) achieved under the legacy fee-for-service system and the regulatory framework of Medicare in general, and Part B specifically.

I believe these proposed changes would have a net-negative impact on my practice. While I appreciate the concepts of the reforms proposed, I am concerned that the policies as drafted would not achieve their stated objectives and would place economic strains on my practice.The pathway to true reform of the Medicare program, especially for primary care, lies in the broader proliferation of Alternative Payment Models (APMs) versus efforts to tweak the legacy fee-for-service system.

I strongly recommend that you consider the alternative proposals outlined in the AAFP's recent letter, as found here: https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-2019ProposedMPFS-090618.pdf

 

[DoubleBogey]

The proposal limits billing to two types of encounters - new or established, that’s it. Rare to bill level 1 unless nurse visit. There is no reward for thinking. Same documentation and risk for less pay. I truly believe this is to decrease overall physician reimbursement and lay the tracks to universal healthcare/Medicare for all (placing tinfoil hat on).

It goes against value based care and continues to promote quantity over quality IMO