CMS releases final 2015 payment rules for Medicare: 10 things to know

By Ayla Ellison for Becker’s Hospital CFO

CMS has released the final rules regarding Medicare payments to physicians, non-physician practitioners, hospital outpatient departments, ambulatory surgery centers and dialysis facilities that treat patients with end-stage renal disease.

Here are 10 things to know about the final 2015 payment rules.

CMS released policy and payment changes to the Medicare Physician Fee Schedule for 2015.

1. Beginning next year, the Medicare Physician Fee Schedule will include a chronic care management fee. The purpose of the fee is to support physician practices in their coordinated care efforts for Medicare beneficiaries with multiple chronic conditions.

2. Regarding the physician fee schedule, CMS said the Administration supports legislation to permanently change the sustainable growth rate “to provide more stability for Medicare beneficiaries and providers.” However, if the sustainable growth rate formula cuts are allowed to take place, healthcare providers could see their Medicare payments reduced by an average of 21.1 percent on April 1, 2015.

3. Concerning the Open Payments program, CMS is deleting the continuing education exclusion, which provided an exemption for payments to speakers at certain accredited or certifying continuing medical education events.

4. Medicare will begin paying for beneficiaries to receive annual telehealth wellness visits. Medicare will also pay for beneficiaries to use psychoanalysis and psychotherapy telehealth services.

CMS released changes to the Value-Based Payment Modifier Program in 2015.

5. The program adjusts Medicare payments to physicians based on the quality and cost of care they provide to Medicare beneficiaries, which leads to payment increases for providers that provide high-quality healthcare while reducing costs. In 2017, CMS will begin applying the value modifier to all physicians, including solo practitioners.

CMS finalized hospital outpatient and ambulatory surgical centers policy and payment changes for 2015.

6. A new comprehensive Ambulatory Payment Classifications payment policy is being implemented next year. Under the policy, a single payment will be made for all related hospital items and services, rather than separate payments for each supportive service.

CMS released to physician quality programs and other programs in the Medicare Physician Fee Schedule.

7. To help aid consumer decision-making, CMS has finalized policies to significantly expand the quality measure data available on the Physician Compare website by making group practice and individual physician-level measures available for public reporting.

8. The final rule makes changes to the quality measures for accountable care organizations participating in the Medicare Shared Savings Program. The total number of measures will remain at 33, but CMS increased the number of measures calculated through claims and decreased the number of measures reported by ACOs through the group practice reporting option web interface. New measures will be added that focus on: avoidable readmissions for patients with multiple chronic conditions, heart failure and diabetes; depression remission; all cause readmission to a skilled nursing facility; documentation of current medications; and stewardship of patient resources.

9. Concerning the MSSP ACOs, CMS also added a quality improvement measure that adds bonus points to each of the four quality measure domains based on improvement. Beginning in 2015, MSSP ACOs can receive up to four points to reward improvements in quality performance.

CMS released updates on policies and payment rates for end-stage renal disease facilities for 2015.

10. To reduce unnecessary hospital readmissions, a Standardized Readmission Ratio will be incorporated in 2017, which assesses the rate at which end-state renal disease dialysis patients return to acute-care hospitals within 30 days of discharge from acute-care facilities.