We’re always curious about reactions to CMS announcements and recently read a comprehensive blog post by McDermott+Consulting, a subsidiary of McDermott Will & Emery (MWE). Their analysis ranges from good to bad to ugly, based on CMS policies being delayed, rescinded or enacted. Below is a summary of the main points; to read MWE’s complete blog, click here.
The ugly news first:
In 2021 CMS created an add-on complexity code (G2211) for office and outpatient E/M codes but delayed its implementation until January 1, 2024. The reason, in a nutshell, is that CMS – in its quest toward budget neutrality in new payment policies – over-shot its expectation of this code’s use, and has since revised it down considerably. This results in a more muted negative payment effect, but MWE estimates that the use of G2211 will reduce physician payments by 2%, especially those whose practice doesn’t allow for additional coding for complexity.
Next, the bad:
CMS’s Quality Payment Model has two tracks: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternate Payment Model (APM) with the goal of transitioning providers from MIPS to APMs. 2024 will make MIPS incentives more challenging and also lessen the incentives to move to APMs – sounds like a rock & a hard place. The performance threshold that determines whether clinicians will receive a bonus or penalty has been 75 points and will move to 82 points next year, with no exemptions. Two other policies will also take effect: increasing the data completeness criteria threshold to 80% for 2027/2029 and lengthening the interoperability performance period from 90 to 18- days.
Advancing to APMs hasn’t been an option for the majority of specialists because the advancement criteria were based on the entity itself and not the individual clinician; this will change for 2024. MWE writes that this change would make it “exceedingly hard” for many clinicians, especially specialists, to meet the thresholds.
And now for the good news:
CMS will delay four policies that could have had great impact on providers: 1) Indefinite delay to the Appropriate Use Criteria Program, requiring practitioners to use a qualified clinical decision support mechanism before ordering advanced diagnostic imaging. 2) Determining the substantive portion in a split/shared service will continue as-is for 2024. 3) Revisions to the Medicare Economic Index are delayed, so RVU weights remain unchanged, for now. 4) Delaying yet again the imposition of financial penalties to providers who do not electronically order at least 70% of eligible controlled substance prescriptions.
Three more “goodish” policies include CMS proposals: 1) for new codes and payment for community health/social determinants of health and expanding access to behavioral health with new codes and an expanded list of eligible clinicians. 2) to simplify the process for adding new codes to the telehealth list, either permanently or temporarily. 3) to allow a higher non-facility payment rate for telehealth for services performed in the patient’s home and a lower rate for services provided to patients not located in their home. 4) and continuing the suspension of frequency limitations for certain subsequent inpatient & SNF visits provided by telehealth.