CMS proposes rule to pay for telehealth, lower Part B add-on, allow MA risk to replace MIPS

The proposed rule would allow patients to text photos to their physicians for evaluation. Medicare-covered telehealth services would include prolonged preventive services.

“Medicare will start paying for virtual check-ins,” CMS Administrator Seema Verma said during Thursday’s press call.

This is not to replace, but to augment office visits, she added.

Another proposal would change the add-on amount for the first two quarters for Part B drugs from 6 to 3 percent, starting in 2019. This is to lower drug costs for seniors, especially for prescriptions with high launch prices, she said.

CMS also proposed waiving MIPS requirements for physicians who participate in Medicare Advantage plans that take on risk. The waiver of MIPS requirements is part of testing a demonstration called the Medicare Advantage Qualifying Payment Arrangement Incentive, or MAQI.

The QPP proposal would also make changes to the MIPS “promoting interoperability” performance category to support greater EHR interoperability and patient access to their health information, as well as to align the clinician program, CMS said.

This reduces the paperwork burden on average of 51 hours per clinician time a year, CMS said.

CMS also proposed removing 34 process measures from MIPS as these measures are topped out, meaning physicians are already performing highly in these areas.

What’s more, CMS is also empowering clinicians to use their electronic health records to document clinically meaningful information, instead of information that is only for billing purposes.

Physicians should not have to put together their notes for documentation requirements for billing purposes, Verma said.

Currently providers have to create medical records that are a collection of predefined templates and boilerplate text for billing purposes, in many cases reflecting very little about the patient’s actual medical care, CMS said.

The proposal is to move from a system of four different sets of documentation requirements to one set that has four code levels. There will one single set of requirements for documentation, Verma said.

The proposal would simplify, streamline and offer flexibility in documentation requirements for Evaluation and Management office visits — which make up about 20 percent of allowed charges under the physician fee schedule and consume much of clinicians’ time.

CMS and the Office of the National Coordinator for Health Information Technology have gotten feedback that CMS’s extensive documentation requirements for Evaluation and Management codes have resulted in unintended consequences.

ONC on Thursday said it supports the proposed changes to the physician fee schedule, as it was tasked by Congress in the 21st Century Cures Act to work with CMS to reduce clinician burden associated with health information technology.

“This proposal would help to significantly reduce administrative burdens imposed on the nation’s clinicians, allowing them to spend more time with their patients,” said National Coordinator Don Rucker, MD. “CMS and ONC heard from stakeholders, specifically physicians, nurse practitioners, physician assistants and other clinicians who bill Medicare that the E/M documentation requirements create a large amount of administrative burden and are frequently not medically necessary.”

The proposals would be budget neutral.

Most providers would be impacted up and down in the 1-2 percent range, with the changes offset by a reduction in administrative burden, Verma said.

Changes in the QPP proposal would collectively save clinicians an estimated 29,305 hours and approximately $2.6 million in reduced administrative costs in 2019.

CMS’s proposal follows through on promises for greater interoperability and its patients over paperwork initiative.

CMS is seeking comment by September 10.