CMS Finalizes Physician Fee Schedule, Quality Payment Program Rules

Changes to the rules are expected to reduce physician burden and foster innovation in healthcare.

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule for the 2018 Physician Fee Schedule and for the Quality Payment Program (QPP), according to a press release.

The revised rules are an effort to reduce regulatory burdens for providers and increase healthcare delivery innovation. The agency said these changes are focused on reducing healthcare costs, increasing competition, and improving the physician-patient relationship.

The CMS reports that changes to the Physician Fee Schedule are in line with President Donald Trump’s priority of lowering drug costs for Americans.

Notably, the CMS is altering the reimbursement for biosimilars in 2018 as a way to increase competition among biologics and ensure that Americans have access to low-cost therapies, according to the release.

The CMS will also pay for more telehealth services and streamline billing for healthcare providers in an effort to improve access for Medicare beneficiaries. This action highlights the agency’s commitment to modernizing reimbursement practices to ensure beneficiaries are experiencing patient-centered care, according to the release.

The finalized rule also includes policies that assist physicians with the transition into the QPP, including those that reduce burdens and provide support for providers in small practices and rural areas.

To further reduce burdens, the CMS is allowing providers in small and rural practices to participate in value-based payments together, according to the release.

In an effort to help practices affected by hurricanes Harvey, Irma, and Maria, the CMS has added a hardship exception to the rule that eliminates penalties for not using electronic health records when it takes place during a natural disaster.

The rule also provides clarity on clinician participation in Advanced Alternative Payment Models, in which clinicians can now receive credit for payment bonuses for their participation. In the future, the CMS plans to develop a demonstration that analyzes the effects of counting as credit participation before 2019 and through 2024 in Medicare Advantage plans, according to the release.

“During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients,” said Seema Verma, administrator of CMS. “These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system.”