Weekly Roundup (September 18-22, 2023)
Physician payment, coding, coverage, and quality reporting news highlights.
So, I am at the CPT Editorial Panel meeting this week. Who doesn’t love spending two days in a windowless conference room debating coding nomenclature? During meeting lulls, I found myself daydreaming of attending Climate Week NYC or as dubbed by climate change activist Oscar Soria, the Burning Man for Climate Change. It was good to see that climate change and health equity and the role of healthcare organizations in addressing climate change were part of the conversation at Climate Week. Building climate resiliency is humanity's most significant problem, and it will take all of us to find a solution.
The significant issue dominating the news this week – which will only require a few hundred men and women to come to a consensus and not all of humanity – was the looming (and the increasingly likely) government shutdown. Lots of ink has been spilled on the government shutdown, so as an alternative is a curated list of the week's non-government shutdown-related health policy news. Enjoy!
PAYMENT
Surprise Billing Update: IDR Portal Status and Proposed Rule Released this Week. No one would blame you if you cannot recall if the Independent Dispute Resolution (IDR) Surprise Billing portal is accepting submissions or is on pause this week. The on-and-off status of the portal is head-spinning, and one needs a scorecard to keep up. The IDR portal is used to arbitrate payment disputes between providers and health plans. Here is where things stand on Friday, September 22, 2023.
IDR Portal Status: On September 21, the Centers for Medicare and Medicaid Services (CMS) announced that IDR entities were to resume processing all single and bundled disputes submitted on or before August 3, 2023.
Proposed Rule. A proposed rule on the fees for the Federal IDR process was released in light of recent litigation.
The agency proposes that, effective January 1, 2024, a fixed certified IDR entity fee for single determinations within the range of $200 to $840. This fee range represents a 20 percent increase to the upper limit from the 2023 single determination fee
The agency proposes that, effective January 1, 2024, a fixed certified IDR entity fee for batched determinations within the range of $268 to $1,173. This represents a 25 percent increase to the upper limit from the 2023 batched determination fee range.
The comment period for the proposed rule is 30 days.
PAYMENT INNOVATION
Are Additional Payment Models in the Offing for 2023? During a recent policy briefing sponsored by Health Affairs, Liz Fowler, director of the Center for Medicare and Medicaid Innovation (CMMI), indicated that the agency may announce two behavioral health models and a maternal health model later in 2023. These models, which are targeted at public health priorities identified by the Administration, could be delayed by a government shutdown. The director acknowledged that these models do not address the integration of specialty care with primary care, a component of CMMI’s strategy refresh announced in November 2022.
Since June, CMMI has announced three payment models, including the Guiding an Improved Dementia Experience (GUIDE) Model, the Making Care Primary (MCP) Model, and the States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD” Model).
CODING
Proposals for New ICD-10 Procedural and Diagnosis Codes Open for Comment. Codes proposed during the recent ICD-10 public meeting are open for public comment. Public comments for code proposals requested for implementation in April 2024 are due by Oct. 13, 2023. Comments for code proposals requested for October 2024 implementation are due by Nov. 15, 2023. Five proposals for procedure items, two for therapeutic agents, and 28 proposals for diagnosis codes are open for comment.
On a sad note, the passing of Donna Pickett, RHIA, MPH, was announced. ICD-10 meeting participants will remember Ms. Pickett as leading the diagnosis portion of the meeting for many years. She provided excellent guidance on the process to members of the public and managed the meetings professionally and with great competence and expertise.
CLIMATE CHANGE
Joint Commission Launches Sustainable Healthcare Certification Program: The Joint Commission has developed a new voluntary Sustainable Healthcare Certification (SHC) program that will be effective January 1, 2024. This certification program evaluates whether hospitals and critical access hospitals have put in place key structures and processes to improve energy efficiency, decrease their carbon footprint, and decrease waste. The hospitals will have to (1) identify environmental sustainability and decarbonization as a strategic priority and allocate the resources to reduce their carbon footprint and (2) measure their greenhouse gas emissions and draft plans to reduce them.
OTHER NEWS, IN BRIEF
Primary Care Bill Advances. This week, the Bipartisan Primary Care and Health Workforce Act advanced in the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee. The bill passed with a bipartisan 14-7 vote. Estimated to cost $26.2 billion, it would provide funding for community health centers and bolster the doctor, nursing, and dentist workforces. The funding of the legislation has been controversial, which includes costs in other healthcare sectors. Certain stakeholders, in particular hospitals, have raised concerns that these cuts could harm patient access to care. While this legislation is coming out of a committee chaired by Senator Bernie Sanders (I. VT) and may seem to reflect the Senate’s position, it is not expected to pass in the House.
Milestone Reached in Reducing Stigmatizing Mental Health Questions in Licensing Applications. This week the Dr. Lorna Breen Foundation recognized licensing entities for making strides in the addressing the stigma around seeking mental health care. As part of the Dr. Lorna Breen Heroes’ Foundation Annual State of Our States: WellBeing First Champions, half (25) of state medical boards are recognized as WellBeing First Champions for changing invasive and stigmatizing mental health questions in their licensing applications, a 47% increase from last year. For the first time, 12 health systems, including 75 hospitals and 59 urgent care centers, are also recognized as WellBeing First Champions for making these changes to credentialing applications. It is believed that the reduction in these questions will make it easier for healthcare professionals to seek mental health services when needed. The mission of the Foundation is to reduce burnout of health care professionals and safeguard their wellbeing and job satisfaction.
OPPORTUNITY TO ENGAGE
Engage in Telehealth. The Alliance for Connected Care is soliciting support for a joint letter to Congress asking them to pass the Telehealth Expansion Act of 2023. The Telehealth Expansion Act would make permanent the CARES Act authority enacted at the start of the COVID-19 pandemic that enabled employers/health plans to provide covered telehealth services to individuals with a high-deductible health plan coupled with a health savings account (HDHP-HSA) before their deductible is met. This policy is currently set to expire on December 31, 2024. The deadline to sign is Friday, October 6.
ARTICLES THAT GRABBED OUR ATTENTION
This week, these articles grabbed our attention; we thought they would also interest you.
Telehealth Visits Billed at a Lower Level of Service than Office Visits, Study Finds (HealthcareDive, September 15, 2023.
A Doctrine in Name Only — Strengthening Prohibitions against the Corporate Practice of Medicine (New England Journal of Medicine, September 14, 2023)
UPCOMING EVENTS
Events scheduled for next week (September 25-29, 2023 ) are below. For a complete list of upcoming health policy events and deadlines, please visit our new Health Policy Calendar.
Sept. 27
How The Ownership and Structure of Health Care Entities Affect Clinicians & Patients, Health Affairs Briefing.
Sept. 27-30
American Medical Association (AM) RVS Update Committee (RUC) Meeting.
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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