AMA Applauds CMS Final Rule on Physicians Payment Fee Schedule

The American Medical Association (AMA) recently applauded the Centers for Medicare & Medicaid Services (CMS) for making substantive changes to the policies in Medicare’s proposed Physician Payment Fee Schedule rule. The announced policy changes adhered to AMA-recommended changes from the proposed rule in areas that will improve patient care and save taxpayer dollars.

“This annual policy fine-tuning is an opportunity for CMS to improve treatment options for patients and streamline bureaucratic demands on physicians” said AMA President Andrew W. Gurman, MD. “By expanding coverage of the Medicare Diabetes Prevention Program (DPP) and revising data collection efforts, CMS is ensuring that patients and physicians will benefit from better care and more rational directives.”

Most notably, the AMA welcomed changes in the following areas:

Expansion of Diabetes Prevention Program. CMS agreed to expand coverage of the Medicare DPP model to Medicare patients at risk of developing type 2 diabetes. This expansion will ensure at-risk seniors and people with disabilities have access to an evidence-based DPP that can help them lower their risk factors and prevent or delay the progression to type 2 diabetes.

The expansion also underscores the success of a three-year demonstration project of the YMCA of the USA, funded by Center for Medicare and Medicaid Innovation (CMMI), where the AMA partnered with local YMCAs and 26 physician practice sites in eight states to increase physician referrals of individuals with prediabetes to evidence-based DPPs at local YMCAs.

The pilot program projected an estimated savings of $1.3 billion, prompting CMS to conclude earlier this year that the expanded coverage would result in significant cost savings. This is a groundbreaking policy decision to cover evidenced-based prevention activities that improve patient health and reduce total health expenditures. This also marks the first time that CMMI has used its waiver authority to expedite coverage of a new delivery model that has reduced spending without reducing quality of care. Given the potential to improve the health of millions of seniors with prediabetes, the DPP expansion is an important example of how the CMMI’s waiver authority can work as intended.

Data collection on surgical global codes. CMS listened to the AMA and the physician community to revise the data collection efforts on global surgical codes. CMS’s original proposal would have added a significant burden to physician practices of all sizes. The new proposal is far more reasonable in its approach to data collection and more consistent with congressional intent.

Enhanced coverage of care management and care collaboration. The proposal, which includes input from the RVS Update Committee and the Current Procedural Terminology Editorial Panel, will ease the administrative reporting burden and expand the opportunity to perform and report chronic care management services. Additional new codes provide for payment for assessment and care planning for patients with cognitive impairment and provide for payment for new care collaboration models between primary care physicians and psychiatrists.

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AMA Applauds CMS Final Rule on Physicians Payment Fee Schedule

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