Weekly Roundup (October 23-27, 2023)
Physician payment, coding, coverage, and quality reporting news highlights.
This week on the health front, we finally have a Speaker of the House, one with a decidedly conservative record on healthcare. We now may begin to see more work towards avoiding a government shutdown that had been temporarily delayed when Congress enacted a continuing resolution through Nov. 17. The other health news of note is that the Senate Health, Education, Labor, and Pensions (HELP) Committee advanced President Biden’s nominee for Director of the National Institutes of Health (NIH), Monica Bertagnolli, MD, an oncologic surgeon and cancer researcher; and current director of the National Cancer Institute. It will now move for a full vote on the Senate floor, which is yet to be scheduled. The nomination had been in jeopardy due to objections raised by the HELP chair, Senator Bernie Sanders (I. VT).
It was a bleak week, with too much CNN and feelings of being overwhelmed by the seemingly nonstop devastating news from around the world and closer to home. One spot of joy this week was when I caught up with an old friend I had not seen in a while. We talked about family and friends, and in that hour, all the bad news of the day was shut out. If I were a doctor, I would prescribe the same to all of you, but since I am not, all I can do is urge you to take a break this weekend from your 24-hour news channel of choice and spend a little time with your dear friends and family.
And now, on to the weekly update – it is short and sweet this week.
PAYMENT
Clinician Payments, Telehealth, and Medicare Advantage (MA) are on Tap for the Medicare Payment Advisory Commission’s (MedPAC’s) 2023-2024 Work Plan. On October 24, MedPAC released its 2023-2024 analytic agenda. In addition to its March and June Reports to Congress, they are required by statute to issue every year, MedPAC noted other priority areas that are driving their work this cycle. They are focused on a range of MA issues, including quality, cost, and encounter data collection. They are conducting an analysis of telehealth and updates to clinician services. You may recall that MedPAC held a public meeting on Medicare’s payment methodology for physician and other healthcare professional services earlier this month. At this meeting, there seemed to be a general consensus among Commissioners that there was a need to update the methodology.
Although MedPAC is just an advisory body to Congress and Congress is not required to follow their recommendations, over the years, MedPAC’s work has influenced change in the Medicare program and spurred action by Congress.
PAYMENT INNOVATION
CMS Teases Announcement of New Initiative: The National Health Plan Work Group. In agenda materials about the upcoming annual Learning Action Network (LAN) meeting, the group announced that details of this new initiative would be released. Materials indicate that this group will convene leaders from large national health plans and CMS to accelerate payment reform at the national and local levels. LAN will also be announcing the establishment of the Person Perspectives Council.
Established by the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) launched LAN in 2015 to guide public and private efforts to move away from fee-for-service and towards value-based care.
CODING
Results of September 2023 CPT© Editorial Panel Meeting Released. Referred to as the “Summary of Panel Actions,” the document provides a high-level summary of the meeting, providing a list of Category I and Category III codes that the CPT Editorial Panel has approved. Category I codes established at this meeting are generally effective January 1, 2025, and will likely be surveyed for the January 2024 RVS Update Committee (RUC). The recommended work RVUs and direct practice expense inputs approved by the RUC are then sent to the Medicare agency for their consideration for the 2025 Medicare Physician Fee Schedule.
For public health reasons, new CPT codes 96380 and 96381 that describe the administration and counseling of RSV for infants were fast-tracked, effective October 6, 2023. Obtaining a CPT code was critical in facilitating insurance coverage for a drug that costs nearly $500 a dose. Recent news reports have indicated a shortage of the drug, in particular the 100-milligram dose, which is given to babies weighing more than 10 pounds.
OTHER NEWS, IN BRIEF
The Advanced Research Projects Agency for Health (ARPA-H) Launches a Clinical Trial Initiative and Seeks Feedback from Organizations and Other Stakeholders. The Advancing Clinical Trial Readiness (ACTR) initiative aims to improve the nation’s ability to conduct clinical trials safely, quickly, and equitably and improve clinical trial access for people in communities across the country. A stated goal is to enable 90% of all eligible Americans to take part in a clinical trial within a half hour of their home. ARPA-H seeks feedback from stakeholders with a deadline of December 1, 2023. After the feedback period, ARPA-H will likely release the final initiative description and funding opportunity in the coming months.
This initiative is aligned with and supports the agency’s overall goal of promoting the development of life-saving breakthroughs and accelerating the development of high-impact solutions targeted at the most challenging health problems.
WHAT WE ARE READING
More New and Existing Patient Visits Coded at Level-of-Service Four After Billing Code Changes Took Effect in 2021. (Epic Research; October 24, 2023).
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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