As published in www.aapc.com Healthcare Business News December 2014
CMS released final rules outlining how Medicare will pay healthcare providers and suppliers in 2015. According to an October 31 CMS News press release, “The rules reflect a broader Administration-wide strategy to move our health care system to one that values quality over quantity and spends taxpayer dollars more wisely by finding better ways to deliver care, pay providers, and distribute information.”
The final rules include:
• Better coordination of care for beneficiaries with multiple chronic conditions. Under this year’s rulemaking, the Medicare Physician Fee Schedule will include a new chronic care management fee beginning next year.
• Paying providers for quality, not quantity of care. In 2015, Medicare is continuing to phase in the value-based payment modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish.
• Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center rule includes provisions that promote greater packaging of payments for items and services, rather than making separate payments for each individual service.
• Better information for providers to understand the total scope, cost, and quality of care that the Medicare beneficiaries they serve receive. To assist physician groups and physicians in improving quality of care for their Medicare beneficiaries, CMS recently made Quality and Resource Use Reports available.
• Expand and add new measures to the Physician Compare website. CMS has finalized policies to significantly expand the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures and measures collected by qualified clinical data registries.
• New quality and performance measures for dialysis facilities. The rule incorporates in 2017 a standardized readmission ratio, which assesses the rate at which ESRD dialysis patients return to an acute care hospital within 30 days of discharge from an acute care hospital … to reduce unnecessary hospital readmissions in all settings.
CMS fact sheets on final payment rules are available at: