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CMS cuts another 20% from off-campus facility payments

Physician fee schedule final rule also updates payments for biosimilars, pays for more telehealth and provides detail on participation in APMs.

Susan Morse, Senior Editor

Credit: <a href="https://en.wikipedia.org/wiki/United_States_Department_of_Health_and_Human_Services#/media/File:DHHS2_by_Matthew_Bisanz.JPG">Matthew Bisanz</a>.Credit: Matthew Bisanz.

The Centers for Medicare and Medicaid Services has released a final rule on the physician fee schedule that cuts 20 percent from off-campus hospital payments.

This is on top of cuts to off-campus hospital facilities made last year.

[Also: CMS cuts another 20% from off-campus facility payments]

"We're particularly troubled that these cuts for off-campus, provider-based departments--an additional 20 percent reduction to rates already cut in half by regulation last year--come without an analysis of how they might harm patient care," said Bruce Siegel, MD, CEO of America's Essential Hospitals.

Rural providers in "healthcare deserts" overcome practitioner shortages by extending primary and specialty care services to off-campus clinics, Siegel said.

[Also: Meaningful Measures show just how committed CMS, ONC are to cutting regulatory burdens]

This change and yesterday's Medicare Part B drug payment cut in the Outpatient Prospective Payment System final rule will combine to jeopardize the health of low-income Americans, he said.

The final rule also updates payments for biosimilars, pays for more telehealth and makes it easier for providers to bill for these services, and provides additional detail on clinician participation in advanced alternative payment models under MACRA.

Clinicians can receive credit for payment bonuses through participation in APMs. CMS said it intends to develop a demonstration project testing the effects of counting as credit, participation in Medicare Advantage plans prior to 2019 and through 2024.

Additionally, the rule includes a number of policies designed to provide clinicians with a smoother transition to the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act, CMS said.

The QPP final rule includes policies to decrease the number of clinicians in small and rural areas required to participate. CMS is adding an option to help clinicians and small, rural practices join together and share the responsibility of participating in value-based payments.

CMS is also adding a new hardship exception to assist small practices and clinicians impacted by hurricanes Harvey, Irma, and Maria. This change mitigates the absence of electronic health records as a result of the natural disasters.

CMS said wants consumers to have access to lower-cost alternative to drugs known as "biologicals."

"This change promotes competition to ensure millions of patients will have access to new lower cost therapies," CMS said.

The provisions are effective Jan. 1, 2018.

"During my visits with clinicians across the country, I've heard many concerns about the impact burdensome regulations have on their ability to care for patients," said CMS Administrator Seema Verma.  "These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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