Society Submits Comments on CY 2017 Physician Fee Schedule

This week, AMDA-The Society for Post-Acute and Long-Term Care Medicine submitted comments to the Centers for Medicare & Medicaid Services (CMS) on their proposed rule entitled Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release; Medicare Advantage and Part D Medical Low Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Proposed Rules.

The proposed rule has a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.

The Society applauded CMS’ efforts to continue to address the unique needs of the post-acute and long-term care (PALTC) population. “We continue to support CMS proposals that aim to improve payment structure for physicians practicing PALTC medicine. We believe proposals for new coding initiatives and payment models that take the unique needs of this vulnerable population that continues to grow will help achieve the health care goals set out by the Secretary.”

In its letter the Society supported the following proposals:

• Additional of advance care planning code to approved telehealth services
• Support for removal of one per 30 day telehealth services limit for SNF subsequent care codes
• Add-on codes for Chronic Care Management (CCM) services
• Payment for complex Chronic Care Management (CPT codes 99487 and 99489)
• Requiring hospitals to disclose list of patients eligible for 3-day stay exemption for SNF benefit as well as holding ACO, rather that SNFs, accountable for payment issues.

Telehealth Services

Advance Care Planning

The Society supported the expansion of a Medicare telehealth benefit for advance care planning throughout the beneficiary’s life, not just at the end of life and noted that “Many physicians who practice PALTC medicine are in rural areas and are not always on site. The addition of this code to the list of approved telehealth services would allow for structured discussions about a patient’s illness and goals which will facilitate improved communication during transitions between providers, patients, and family caregivers.”

SNF Subsequent Care Codes

Although CMS made no proposals in regards to telehealth services for SNF/NF subsequent visit codes (99307-99310), the Society suggested that CMS should remove the previous requirement that limited the use of telehealth services to once per 30 days. While the Society agreed that patients in SNFs are complex and require face-to-face visits, new payment models should allow for use to telehealth services as medically necessary to align with other requirements. Arbitrary limits could have unintended consequences and limit practitioners' ability to take care of patients when medically necessary to avoid hospital readmissions and other adverse outcomes.

New Payment Codes

Add-on CCM Services

In the proposed rule CMS is proposing an add-on payment for Chronic Care Management (CCM) services that involve assessment for, and development of, a new care plan. The proposed code descriptor is: Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed separately from monthly care management services. (Add-on code, list separately in addition to primary service). The Society noted their appreciation that CMS is recognizing the time and work it takes to develop and implement a care plan for patients with two or more chronic conditions. “Physicians who practice PALTC medicine take care of patients with multiple chronic conditions and very often coordinate that care with other specialists and consistently monitor and update the care plan in conjunction with the skilled nursing facility or other providers," said the Society.

Complex Chronic Care Management Services (CCCM)

CMS also is proposing to make separate payments for complex CCM (99487 and 99489) which entails at least 60 or 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with specified required elements. The Society was particularly pleased to see the inclusion of the complex care management code. The Society worked alongside many other primary care groups and CMS over the last several years to develop and establish payment for the code. The Society urged CMS to provide clear detail on requirements and places of service in which these new codes can be billed and to align requirements with the already established CCM codes.

Hospital 3-day Stay Exclusions

CMS also inquired whether it is reasonable to hold affiliate SNFs responsible for all claims rejected solely as a result of lack of a qualifying inpatient hospital stay and whether the ACO rather than, or in addition to the SNF affiliate should be held liable for such claims, and under what circumstances. The Society noted that it “feels that ACOs should hold the majority of the liability. In such arrangements SNFs should not be accountable for identifying waiver-eligible patients and we propose that CMS require hospitals to share the list of waiver-eligible Track 3-enrolled beneficiaries with all of their ACOs and partner SNFs. The ACOs, rather than the SNFs, should be held accountable for payments related to this waiver. “

The final rule is expected in November of 2016.