CMS Physician Payment Rule Seeks to Improve Patient Care

The finalized rule will improve payment for care relating to chronic diseases, mental health, and cognitive impairment.

The US Centers for Medicare and Medicaid Services (CMS) recently finalized the 2017 Physician Fee Schedule rule, which also expands the Diabetes Prevention Program model.

This finalized rule recognizes how important primary care is through improving payment for managing chronic care and behavioral health conditions.

The expanded Medicare Diabetes Prevention Program model will be the first time a prevention model from the Innovation Center will be adopted under the organization’s authority to increase the reach of payment and service models, according to a press release from CMS.

The new 2017 Physician Fee Schedule is a rule that truly demonstrates the federal government’s commitment to creating a better healthcare system that includes better care, smart spending, and a healthier population.

The finalized rule will improve how Medicare pays for primary care services provided by physicians and other healthcare professionals treating patients with chronic conditions, mental health issues, behavioral health issues, and cognitive impairment. The rule will now improve how clinicians are paid for additional time and resources needed to implement coordinated and patient-centered care, according to the CMS.

These new changes will also better align Medicare’s priorities and rewards for physician who provide quality care through the Quality Payment Program.

Earlier this year, the CMS announced the Diabetes Prevention Program model was able to expanded, and they are now will allow CDC-recognized suppliers to prepare to enter Medicare and submit claims.

“Through the Medicare Diabetes Prevention Program expanded model, eligible beneficiaries will be able to access a community-based intervention that prevents diabetes and keeps people healthy,” said Patrick Conway, Acting Principal Deputy Administrator and CMS Chief Medical Officer. “Preventing the onset of diabetes through proven measures not only keeps people living healthier lives, but also helps to preserve Medicare. This is an exciting milestone for prevention and population health.”

The CMS estimates that Medicare will spend $42 billion more in 2016 for patients with diabetes than it would spend if they did not have diabetes. With this expansion, they are hoping that employers and insurers will take part in diabetes prevention programs in younger populations.

The finalized 2017 Physician Fee Schedule also finalizes a new data collection strategy for worldwide services with a reduced burden for physicians, according to the press release. Additionally, a sample of practitioners selected to will be required to meet various reporting criteria, and those who were not chosen will have limited reporting requirements.

“These policies will give significant support to the practice of primary care and boost the time a physician can spend with his or her patients listening, advising and coordinating their care,” said CMS Acting Administrator Andy Slavitt. “By better valuing primary care, behavioral health, and prevention models like the Medicare Diabetes Prevention Program expanded model, we help beneficiaries access the services they need to stay well and live long, healthy lives.”