CMS to pay for behavioral health, more collaborative care, in new proposed physician fee schedule

CMS Headquarters-Windsor Mill, MD.

The Centers for Medicare and Medicaid Services has proposed changes to how it pays doctors and other providers for primary care with a new focus on care management and behavioral health.

CMS on Thursday released the physician fee schedule changes that updates payment policies, payment rates, and quality provisions for services provided in calendar year 2017.

In general, the proposed policies are around primary care and care coordination; mental and behavioral health; cognitive impairment care assessment and planning; and care for patients with mobility-related impairments.

Services include visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.

CMS is proposing to pay for specific behavioral health services furnished using a team approach in a collaborative care model. The team includes a primary care practitioner, behavioral health care manager, and psychiatric consultant.

In addition to physicians, the fee schedule pays nurse practitioners, physician assistants, physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.

CMS is proposing a new code to pay for cognitive and functional assessment and care planning for patients with cognitive impairment, such as for patients with Alzheimer's.

The rule proposes revisions to payment for chronic care management, including payment for new codes and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.

CMS said it will pay physicians more accurately for furnishing services to beneficiaries with mobility-related impairments.

The rule also includes policies to expand the diabetes prevention program within Medicare starting January 1, 2018.

Comments are due on Sept. 6.

The American Medical Association commended parts of the CMS plan, as it pertains to the expanded coverage for the prevention of type 2 diabetes and the new ways to report and pay for high-value care collaboration and care management services.

The AMA, however, said the proposal to collect information on every 10-minute increment of patient care provided by physicians as part of activities before and after each surgery/procedure is unnecessarily burdensome.

The new set of regulations comes as physicians are attempting to successfully comply with MACRA, the AMA said.

The AMA also opposes CMS' plan to eliminate the physician payment increase that Congress provided for 2017 in the MACRA legislation and repurpose that money to fund a newly proposed add-on payment for services provided to patients with mobility impairments. 

"Getting this policy right is vital, and the AMA will be submitting formal comments to CMS before the final version is released later this year. There is a lot of work ahead," said AMA President Andrew W. Gurman, M.D. 

The proposal was released the day after CMS proposed updated payment rates and policy changes in the hospital outpatient prospective payment system and ambulatory surgical center payment system.

The changes are intended to address physicians' concerns regarding pain management; focus payments on patients rather than setting; improve patient care through technology; and emphasizing health outcomes that matter to the patient.

CMS estimates that the updates in the proposed rule would increase outpatient prospective payment system payments by 1.6 percent and ambulatory surgical center payments by 1.2 percent in 2017.

One of the new provisions in the rule would reduce outpatient prospective payment system spending by approximately $500 million in 2017 by no longer paying for services at an outpatient department at a higher rate.

The proposal has been met with criticism by at least one hospital organization, America's Essential Hospitals.

Twitter: @SusanJMorse