Primary Care Docs Get Boost in 2017 Medicare Proposal

WASHINGTON -- Primary care is the watchword for 2017 when it comes to the Medicare physician fee schedule proposed Thursday by the Centers for Medicare & Medicaid Services (CMS).

"In the United States, we have historically invested far more in treating sickness than we do in maintaining health," CMS acting administrator Andy Slavitt said in a blog post. "The result of this imbalance is not only poorer health, but more money spent in institutions, hospitals, and nursing homes."

"The road to a better health care system means correcting this imbalance," he continued. "We should reinvest in what we value -- primary care -- as a practice, as a profession, and as an abundant resource for patients."

"Today, we are proposing significant actions to improve how we pay primary care physicians, mental health specialists, geriatricians, and other clinicians. By better valuing primary care and care coordination, we help beneficiaries access the services they need to stay well."

Under the proposed rule, Medicare would:

• Increase primary care provider payments for routine office visits involving patients with mobility-related disabilities, raising the payment from $73 to $119 per visit.
• Increase payments to geriatricians and family physicians. "We anticipate that these clinicians could receive a 2% increase in their payments for providing the care we propose to recognize under the Physician Fee Schedule," Slavitt said in the blog post. "Over time, if all of the practitioners that can provide these services provide them to all eligible patients, we estimate that the payment increase could be as much as 30% and 37%, respectively, to these specialties."
• Pay for mental healthcare using the behavioral health Collaborative Care Model, which "supports mental and behavioral health through a team-based coordinated approach involving a psychiatric consultant, a behavioral healthcare manager, and the primary care clinician, and which extends beyond the scope of an office visit," Slavitt said.

The proposed fee schedule, which will be finalized this fall, is the second to be issued since Congress repealed the much-abhorred sustainable growth rate (SGR) payment formula in April. The SGR repeal bill, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), specifies an overall 0.5% increase in physician fees each year through 2019; no additional overall increase was mentioned in Thursday's announcement.

Diabetes prevention was another big focus in the proposed fee schedule. CMS is proposing to expand the Diabetes Prevention Program into Medicare starting in 2018. The program "is a structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic," CMS explained in a fact sheet on the proposed rule. It consists of 16 intensive group educational sessions succeeded by less-intensive monthly follow-up meetings.

The agency is seeking comment on a number of provisions for expanding the prevention program, such as having prevention program suppliers obtain a National Provider Identification number; paying for the program based on the number of sessions the patient attends as well as achievement and maintenance of a minimum weight loss; and defining an eligible beneficiary as one with a body mass index of 25 or greater; an HbA1c of 5.7%-6.4% or fasting plasma glucose of 110-125 mg/dL within the last 12 months, or 2-hour plasma glucose of 140-199 mg/dL after a 75-g oral glucose tolerance test; and no previous diabetes diagnosis.

CMS also proposed changes in payment for endoscopic procedures that involve sedation. Previously, sedation was included in the payment to the physician performing the procedure, even though anesthesia was being reported separately; the agency is now proposing to implement separate moderate sedation codes, including an endoscopy-specific moderate sedation code.

In the telehealth area, CMS proposes to make several more services provided via telehealth payable, including end-stage renal disease services, advance care planning services, and critical care consultations.

The agency also is proposing new CPT coding for mammography services to reflect the use of current technology "including a transition from film to digital imaging equipment and elimination of separate coding for computer-aided detection services."

Regarding accountable care organizations (ACOs), CMS is proposing "revisions that would permit eligible professionals in ACOs to report quality apart from the ACO, and updates to align with the Physician Quality Reporting System and the proposed Quality Payment Program," the agency said.

Washington correspondent Shannon Firth contributed to this story.

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Primary Care Docs Get Boost in 2017 Medicare Proposal