Our Take: Trump’s executive order, CMS’ proposed payment rules offer hope to rural areas
President Trump signed an executive order last Monday directing the Department of Health and Human Services (HHS) to come up with strategies to improve health outcomes for residents in rural areas, and to permanently extend changes that have increased Medicare beneficiaries’ access to telehealth services during the public health emergency (PHE). Hours later, CMS released its proposed changes in the Physician Fee Schedule (PFS) for 2021, some of which coincide with those directives and others set forth in the executive order.
As part of the directive to improve rural health care, the executive order tasks HHS with reducing providers’ regulatory burdens and launching a new payment model that will establish predictable payments for providers and encourage them to transition to value-based care. Further, HHS and the Department of Agriculture, in conjunction with the Federal Communications Commission, are to develop a plan to increase broadband connectivity for better access to telehealth in rural areas.
In the last few months, CMS has added 135 services that can be reimbursed when delivered using telehealth. A CMS fact sheet for the proposed PFS changes shows that telehealth services listed under nine HCPCS codes will become permanent — including certain evaluation and management services and certain services conducted during home visits. In addition, services listed under 13 other HCPCS codes — including some for home visits and emergency department visits — will be covered through the calendar year in which the PHE ends; CMS could later decide to make those permanent as well.
The American Medical Association (AMA) noted in a statement that, because of a budget neutrality requirement, the additional spending resulting from payment increases in the proposed PFS would necessitate lowering the Medicare conversion factor used to calculate reimbursement rates by approximately 11%. In general, primary care providers, including nurse practitioners, stand to benefit, but some specialty providers, such as physical and occupational therapists, would see significant cuts in reimbursement. Surgeons also would see their reimbursement rates slashed by 6% to 9%. The AMA said it “strongly urges Congress to waive Medicare’s budget neutrality requirement for the office visit and other payment increases.”
The proposed PFS also includes changes to the Merit-based Incentive Payment System, the Quality Payment Program, and the Medicare Shared Savings Program. Of note, for the 2020 performance year, CMS is seeking to modify how quality is benchmarked by changing how shared savings and shared losses are determined and is seeking comment on an alternative scoring methodology that would help protect providers in “extreme and uncontrollable circumstances” like the pandemic.
On Tuesday, CMS released its proposed changes for 2021 for the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System.
One notable change is the proposed elimination of the inpatient-only list over the next three years, starting with about 300 musculoskeletal-related services in 2021. CMS also proposed adding 11 procedures that Medicare would pay for when performed at an ambulatory surgical center (ASC). Payment rates for hospital outpatient departments and ASCs would increase by 2.6% under the proposed rule.
Another notable change is the proposed 28.7% net rate reduction in payments for drugs and biologicals that hospitals acquire through the 340B program. CMS has been embroiled in a legal battle with hospital groups over its 340B rate cut, but an appeals court ruled recently that the agency has the authority to implement the reduced rate.
While many of these measures would greatly benefit patients and providers, it’s going to be a while before they can be implemented.
The executive order gives HHS 30 to 60 days to come up with a strategy or to report on recommendations for the various directives, and both of CMS’ proposed rules include a 60-day period for public comment before they can be finalized. Moreover, Congress would need to be involved before broader expansion to telehealth rules, such as reimbursement for home health agencies, could occur. Then comes the hard work of actually putting the processes in place.
Still, measures that would eventually give residents in rural areas more access to the health care they need are steps in the right direction. So are measures that would alleviate the administrative burden on providers and more adequately compensate them for their time and services — especially providers in smaller practices that are reeling from the effects of the pandemic.
With tens of thousands of new COVID-19 cases emerging daily and rural areas experiencing significant surges, it feels like every day counts. It’s hard to predict what things will look like two months from now, much less by the time changes can be made and have an effect. We’ll hope for the best.
In theletter, the AGs said they believe it’s clear that Gilead has failed on both counts. As an alternative, the AGs asked the agencies to assign the march-in rights to individual states. In acompany statement, Gilead said the AGs’ letter “is premised on multiple factual inaccuracies,” and that the regulatory actions the AGs requested are “unauthorized under these circumstances” and “will do nothing to speed access to remdesivir.”