Weekly Roundup (September 4-8, 2023)
Physician payment, coding, coverage, and quality reporting news highlights.
Despite it being over 90 degrees in DC this week, we have entered the unofficial start of Fall – and no, I am not speaking of the arrival of pumpkin spice lattes at Starbucks – but of the bellwether of Fall for those of us who follow health policy news. This week, the Medicare Payment Advisory Commission (MedPAC) had its first Fall meeting. August recess is over, the Senate returned this week, and the House is back next week. Are we beginning the frenzy to avoid a government shutdown by September 30? A much closer deadline looming for some procrastinators is Monday, September 11, when comment letters for the physician and hospital outpatient proposed rules are due. Hopefully, you have submitted your comment letters and can enjoy the upcoming weekend!
PAYMENT
MedPAC Identifies Increasing Intensity of Office Visits as a Factor of Future Growth in Medicare Spending. During their September 7, 2023, meeting, MedPAC discussed a draft of a chapter to be included in their March 2024 report to Congress that examines trends and factors in Medicare spending. Growth in volume and intensity of services delivered per beneficiary was identified as one of three factors influencing the expected growth in Medicare’s future spending. This factor has been identified in previous reports. In the staff presentation, growth in reporting of higher-level office visits, CPT code 99214, and a commiserate reduction in the reporting of CPT code 99213 was identified as an example of Medicare paying for a more “intense” mix of services.
Source: Medicare Payment Advisory Commission, September 2023 public meeting.
When Commissioners dug deeper into this issue, they discussed without coming to a consensus if this increase in reporting of 99214 was the result of demands on clinicians to do more during office visits (and thus the increase in work justifying the reporting of a higher-level office visit) or if other factors were driving this trend in increased reporting of higher-level office visit codes. Comments from interested parties on issues discussed during the MedPAC public meetings may be submitted via email up to 14 days following the respective meeting.
COVERAGE
Six Weeks After Congress Calls for Greater Transparency, CMS Releases Update on National Coverage Determination (NCD) Requests Status. The NCD dashboard indicates that two NCDs were finalized in the last 12 months, four open NCDs, and seven NCDs are on a waitlist. The agency notes that in the current environment of a growing volume of requests and limited resources, they cannot always begin the review process immediately, and some requests must be put on a waitlist. Over the years, questions have been raised regarding the internal capacity of the CMS Coverage team.
On July 14, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and House Ways and Means Committee Chair Jason Smith (R-MO), and other members of the Committee sent a letter to CMS calling for more transparency in how CMS makes NCDs following the recent proposal of its Transitional Coverage of Emerging Technologies notice.
CODING
CMS Releases Guidance on Reporting Z Codes. The infographic provides information on using Z codes to report health equity data. Z codes (Z55-Z65) are a set of ICD-10-CM codes introduced in FY 2016, used to report social, economic, and environmental determinants that affect health and health-related outcomes. Medicare, Medicaid, and commercial payors use Z codes in health equity and performance improvement initiatives. Although reporting of Z codes has improved in recent years, they are still largely underreported.
PAYMENT INNOVATION
CMS Unveils a Cost-of-Care Model. On September 5, 2023, the Centers for Medicare and Medicaid Services announced the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. AHEAD is a state total cost of care (TCOC) model. Under a TCOC approach, a participating state uses its authority to assume responsibility for managing healthcare quality and costs across all payers, including Medicare, Medicaid, and private coverage. The AHEAD Model will provide participating states funding and other tools to address rising healthcare costs and support health equity. This model is based on lessons CMS learned from previous models, including the Vermont All-Payer Accountable Care Organization (VT ACO) Model, the Maryland Total Cost of Care Model (MD TCOC), and the Pennsylvania Rural Health Model (PARHM).
OTHER NEWS, IN BRIEF
Surprise Billing Update: Independent Dispute Resolution (IDR) Process Resumes. On September 5, CMS announced they are resuming single and bundled disputes submitted on or before August 3, 2023. All other aspects of Federal IDR process operations remain suspended. Previously, CMS had temporarily suspended all processes after a court ruling in favor of the Texas Medical Association to rescind several No Surprises Act regulations related to the IDR process.
Regulations Released. The following regulations were recently released.
Discrimination on the Basis of Disability in Health and Human Service Programs or Activities. The proposed rule updates and clarifies requirements under Section 504 of the Rehabilitation Act that prohibit discrimination based on disability in programs receiving financial assistance from the department, including health care. The rule will be published in the Federal Register on September 14, with comments due November 7.
Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. In a factsheet, the agency states that the proposed rule “consists of three core staffing proposals: 1) minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs); 2) a requirement to have an RN onsite 24 hours a day, seven days a week; and 3) enhanced facility assessment requirements.” The rule was published in the Federal Register on September 6, with comments due November 6.
Republican Lawmakers Release Summary of Draft Healthcare Transparency Legislation. The draft describes provisions focused on healthcare price transparency, site-neutral payment cuts, delay of implementing cuts to the Medicaid Disproportionate Share program and extending funding for certain health programs expiring on September 30. While the draft includes parts from previously passed legislation and has excluded certain provisions to gain bipartisan support, at this time, it is unclear if it will receive support from the Democrats.
OPPORTUNITIES TO ENGAGE
Medicare Drug Price Negotiation Program Patient-Focused Listening Sessions. CMS will host a series of patient-focused Listening Sessions for 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.
CMS Seeks Feedback on New Website. This week, CMS and the CMS Innovation Center launched an updated website. The agency indicated that they worked with stakeholders throughout the development of these website improvements. Website visitors can provide feedback via a Feedback button available on every website page.
UPCOMING EVENTS
Events scheduled for next week (September 11-15) are below. For a complete list of upcoming health policy events and deadlines, please visit our new Health Policy Calendar.
Sept 11
2024 Medicare Physician Fee Schedule Proposed Rule Comment Deadline.
2024 Medicare Hospital Outpatient and Ambulatory Surgical Center Proposed Rule Comment Deadline.
Sept. 12
National Telehealth Conference. Hosted by the Health Resources and Services Administration, the conference will cover telehealth best practices and integrating telehealth into the standard of care.
Sept. 12-13
ICD-10 Coordination and Maintenance Committee Meeting.
Public Listening Session on Telemedicine and Prescribing Controlled Substances Public Listening Session. Hosted by the Drug Enforcement Administration (DEA), the focus of the meeting is to receive comments from stakeholders on prescribing controlled substances via telemedicine.
Sept. 14
House Energy and Commerce Committee Titled Hearing of Legislative Proposals to Prevent and Respond to Generic Drug Shortages is Scheduled for 10 a.m. Legislative proposals to prevent and respond to generic drug shortages will be discussed during the hearing.
ARTICLES THAT GRABBED OUR ATTENTION
This week, these articles grabbed our attention; we thought they would also interest you.
AI May Influence Who Can Get or Prescribe Pain Medication (MedPage Today; September 3, 2023).
Recent Changes in Physician Practice Arrangements: Shifts Away from Private Practice and Towards Larger Practice Size Continue Through 2022 (American Medical Association).
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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