CMS Unveils Proposed Rule with Changes to Telehealth, Other Programs

7.19.2018
Leslie Krigstein – VP, Congressional Affairs
Mari Savickis – VP, Federal Affairs

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on July 12 with changes to the Physician Fee Schedule and the Quality Payment Program (QPP). Traditionally, these rules have been separate, however, CMS has combined them this year.

This edition of the proposed rule includes some meaningful updates for CHIME members. On telehealth, CMS says they will be:

  • “Paying clinicians for virtual check-ins – brief, non-face-to-face appointments via communications technology;
  • Paying clinicians for evaluation of patient-submitted photos; and
  • Expanding Medicare-covered telehealth services to include prolonged preventive services.”

The program also continues to attempt to embrace CMS’ “patients over paperwork” initiative by removing Medicare Incentive-based Payment System (MIPS) process-based quality measures that clinicians have said are low value or low priority, to focus on meaningful measures that have a greater impact on health outcomes.

CMS also has proposed to amend the MIPS “Promoting Interoperability” performance category to support greater EHR interoperability and patient access to their health information, as well as to align this performance category for clinicians with the proposed new Promoting Interoperability Program for hospitals.

The proposed rule also includes significant changes to evaluation and management (E/M) payment guidelines. CMS has proposed to reduce administrative burden and improve payment accuracy for E/M visits by blending payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in furnishing primary care and non-procedural specialty generally recognized services. The proposed revision is the first since 1997.

CHIME Public Policy Steering Committee Chair Liz Johnson, MS, RN-BC, and CIO, Acute Hospitals and Applied Clinical Informatics at Tenet Healthcare, praised some of the proposed changes in a statement.

“CMS is certainly heeding calls from the provider community to reduce administrative burdens,” she said. “We support efforts to reduce these burdens on clinicians, whether they were created by paper or electronic processes, and to give physicians more time to care for patients. We also applaud the discussion of expanded telehealth reimbursement, something that has been a priority for CIOs, and we commend efforts to incent use of PDMPs (Prescription Drug Monitoring Programs) as we seek ways to leverage technology in our ongoing efforts to combat the nation’s opioid crisis.”

CHIME’s public policy team is assessing the 1,473-page proposed rule and will provide a detailed synopsis for members soon. We also plan to work with the Public Policy Steering Committee and interested members to provide comments to CMS. Please email us at [email protected] if you would like to participate. The deadline for submitting comments is Sept. 10.   

CMS issued a proposed rule fact sheet and a press release. The full proposed rule can be found here.

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