Weekly Roundup (October 2-6, 2023)
Physician payment, coding, coverage, and quality reporting news highlights.
The weather this past week in DC seems too warm for October, but the 2024 physician and hospital outpatient final rules have landed at the Office of Management and Budget (OMB) for their final review, so that must mean it is Fall. We are now in a real-life Ground Hog Day as we await the countdown to the next potential government shutdown, November 17, the week before Thanksgiving. If you are focused on an end-of-the-year fix to address the scheduled 2024 physician payment cut, sadly, the likelihood becomes less likely the longer budget issues remain unresolved.
PAYMENT
MedPAC Considers Solutions to Addressing Flaws in the Medicare Physician Payment Methodology. The Medicare Payment Advisory Commission (MedPAC) met on Thursday, October 5, 2023. Following a staff presentation, the Commissioners debated if there was a need to make structural changes to the Medicare physician payment methodology. There were several topics that the Commissioners focused on during their discussion.
The Medicare physician payment methodology should be updated. Several Commissioners noted the need for payment updates to be tied to an inflationary update.
Concern was voiced about data shared by MedPAC staff that showed that, in recent years, there has been an increase in the volume and intensity of services furnished. There was some debate about what was driving this increase, for example, if it resulted from increased regulatory, quality, and safety requirements; if it was done to make up for falling prices for services, or if something else was driving this increase.
Several commissioners raised concerns regarding how the payment methodology impacts specialties differently and its impact on reimbursement for primary care services.
There was discussion around MIPS payment adjustments and bonuses established by law for participation in Advanced Alternative Payment Models (APMs) and the differential in physician payment updates in future years for MIPS versus Advanced APM participants. MedPAC staff modeled how this differential in payment updates is unsustainable in coming years.
Several commissioners noted that they were uncomfortable with Advanced APM bonuses. There was a consensus that if MIPS remains in its current form, it would be reasonable for the Advanced APM bonus to be restructured.
At the close of the session, the MedPAC Chair noted they will continue this discussion at future meetings. He also encouraged the submission of comments from interested members of the public. Details on submitting comments to MedPAC are available HERE.
Physician Payment and Hospital Outpatient 2024 Final Rule Watch. The calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Final Rules have landed at the Office of the Management and Budget (OMB), the final step before their release. The rules are usually posted on or around November 1, with an effective date of January 1.
2024 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B (CMS-1784)
Received at OMB: 9/27/2023
CY 2024 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates (CMS-1786)
Received at OMB: 10/02/2023
PAYMENT INNOVATION
CBO Report Finds CMMI Did Not Save Government Money in First 10 Years, But Others Say That Is Not the Full Story. A Congressional Budget Office (CBO) report found that the Center for Medicare and Medicaid Innovation (CMMI) increased direct spending by $5.4 billion between 2011 and 2020. CMMI spent $7.9 billion to operate models, but those models only reduced healthcare benefits spending by $2.6 billion. When CMMI was established as part of the Affordable Care Act, it was expected to save money. In an updated analysis, CBO now believes CMMI will increase spending by an additional $1.3 billion from 2021 to 2030.
Stakeholders have noted there are limitations to the analysis. They point out that the report does not consider the bigger picture of how CMMI has contributed to the overall transition of the U.S. healthcare system from fee-for-service to value-based purchasing, contributing to a decline in spending as well as a general shift in the thinking and approach in developing systems of care.
Note the Medicare Shared Savings Program Accountable Care Organizations are not included in the CBO analysis since CMMI does not technically manage them.
CODING
Medicare Agency Reverses Guidance on Place of Service Code (POS) 27 (Outreach Site/Street). CMS announced that it will accept the new POS code 27 (A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals). Previously, the agency indicated it had not “identified a need” for it. In its updated guidance, the agency suggests that this policy change was made to “align with broader CMS efforts to address economic, social, and other obstacles impacting Medicare beneficiary healthcare access.”
POS codes are two-digit codes placed on healthcare professional claims to indicate the setting in which a service was provided. CMS assigned a non-facility payment rate for POS 27, with October 1 as an effective date. But Medicare administrative contractors have until Jan. 1, 2024, to implement the update.
OTHER NEWS, IN BRIEF
Updates from the Advanced Research Projects Agency for Health (ARPA-H). Established in 2022, ARPA-H supports transformative high-impact research to drive biomedical and health breakthroughs — from molecular to societal — to provide transformative solutions. It has been a busy few weeks for the agency.
The agency is soliciting proposals for a program to develop new technologies that automatically deliver treatments and monitor for disease from within an individual’s body. ARPA-H is hosting a Proposer’s Day on November 16; abstracts are due November 30.
Several funding awards were recently announced. $50 million was awarded to advance technologies that address vulnerabilities in securing healthcare data. $37 million was awarded to fund a project to develop a process to restore damaged or non-functional thymus tissue, an organ responsible for supporting normal immune cell development. $26 million was awarded for developing 3D-printed, fully functional human organs. An agreement of $104 million was signed to establish the Defeating Antibiotic Resistance through Transformative Solutions (DARTS) project. DARTS focuses on developing a set of diagnostic and experimental platforms that can reveal insights into how antibiotic resistance starts, search for new antibiotics, and rapidly identify the right antibiotic to prescribe for a particular infection in real-time.
The agency announced the location of three regional hubs. A hub in Dallas, Texas, will focus on diversifying clinical trials, reaching representative patient populations, and creating better health outcomes for all. A Cambridge, Massachusetts, hub will focus on turning ideas into solutions by working with investors, entrepreneurs, and researchers. A third hub will work with stakeholders and operations and will work with the federal government. This hub will be in the National Capital region. The regional hubs will work with local spokes or community organizations. Ten spokes across the country have been established.
OPPORTUNITIES TO ENGAGE
CMS is hosting a National Stakeholder Call with the Administrator. The call will be held on October 17 from 1:00– 2:00 PM ET. Registration is required—National Stakeholder Call with the CMS Administrator. CMS leadership will provide updates on the CMS strategic vision, the agency’s recent accomplishments, and opportunities for stakeholders to work with the agency.
CMS will host a series of patient-focused Listening Sessions this fall as part of the Medicare Drug Price Negotiation Program. The virtual public Listening Sessions will allow patients, beneficiaries, caregivers, consumer and patient organizations, and other interested parties to share input relevant to drugs selected for the first round of negotiations. The Listening Sessions will be held October 30 – November 15, 2023.
ARTICLES THAT GRABBED OUR ATTENTION
This week, these articles grabbed our attention; we thought they would also interest you.
Science vs. ‘Wokeism’: The Growing Tensions Between the Doctors’ Lobby and the GOP. (Politico, September 30, 2023).
2023 Trends Shaping the Health Economy. (Trilliant Health, September 2023).
UPCOMING EVENTS
Events scheduled for next week (October 9-13, 2023) are below. For a complete list of upcoming health policy events and deadlines, please visit our new Health Policy Calendar.
October 9
Deadline to Request MIPS Targeted Review. MIPS participants can request a targeted review if they believe an error has been made in calculating their score for the 2022 Performance Year.
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For more information and questions, please contact:
Sheila Madhani, MA, MPH
Madhani Healthcare Consulting, LLC
Email: smadhani@madhani-health.com
www.madhani-health.com
Tel: (202) 679-2977