CMS Steps Forward with Proposed Changes to PFS in Wake of SGR Repeal

The Centers for Medicare & Medicaid Services (CMS) took the first step toward the Merit-based Incentive Payment System (MIPS) on July 8 with the release of a proposed rule on payment policies and rates, as well as quality provisions, under the Medicare Physician Fee Schedule (PFS).^1,2 The proposed provisions, which follow in the wake of the Sustainable Growth Rate (SGR) formula repeal last year, will go into effect on January 1, 2016, after a 60-day comment period is completed and the provisions are finalized.²

The CMS is proposing to establish separate payment and a payment rate for advance care planning services by physicians and other healthcare professionals. Furthermore, among other information in the proposed rule are modifications to the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record Incentive Program, and Medicare Shared Savings Program; phasing in public reporting on the Physician Compare website and identifying and adjusting payments for misvalued codes in the PFS will continue.

“We are seeing additional steps moving toward healthcare payment models that focus on quality and cost, rather than on volume. Negative payment adjustments for not satisfactorily reporting PQRS quality measures and application of the value-based modifier are going to affect physician reimbursement,” commented Jinoos Yazdany, MD, MPH, Associate Professor, Division of Rheumatology, University of California San Francisco (UCSF) School of Medicine.

Yazdany is also a previous co-chair of the American College of Rheumatology’s Quality Measures Subcommittee and current chair of the UCSF Research Committee for the Rheumatology Informatics System for Effectiveness (RISE) registry. She said the registry will help rheumatologists during the transition by facilitating participation in the PQRS and allowing physicians to track their performance.

References

1. CMS begins implementation of key payment legislation [news release]. Baltimore, MD: Centers for Medicare & Medicaid Services; July 8, 2015. www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-07-08.html. Accessed July 29, 2015.
   
2. Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for calendar year 2016 [news release]. Baltimore, MD: Centers for Medicare & Medicaid Services; July 8, 2015. www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html. Accessed July 29, 2015.