The Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule and Quality Payment Program proposed rule on Aug. 3. The rule would make permanent certain telehealth and workforce flexibilities provided during the public health emergency, establish payment rates for physicians and other health care professionals for 2021, and make significant changes to the Quality Payment Program.
Physician Fee Schedule
The Physician Fee Schedule section of the rule includes evaluation and management (E/M) documentation and payment changes that were finalized in the 2020 Medicare Physician Fee Schedule final rule, which would increase payment for E/M services in 2021. In order to offset the increase in payment for E/M and other services, the statute requires payment reductions in other services. Therefore, the CMS proposes to decrease the conversion factor significantly from $36.09 to $32.26, a decrease of approximately 11%.
The Physician Fee Schedule rule also proposes changes to coverage and payment for telehealth services after the pandemic ends. The CMS proposes to expand telehealth services by adding services to the Medicare telehealth list on a Category 1 basis for services similar to those already on the list. This would include the newly established E/M visit complexity code and prolonged services code, among others. The CMS would also create a temporary third category of services added to the Medicare telehealth list, encompassing some of the services that the CMS allowed to be billed via telehealth during the COVID-19 public health emergency (PHE). These services would remain on the Category 3 list through the calendar year in which the PHE ends. The CMS is also seeking feedback on services that were added to the Medicare telehealth list temporarily during the PHE that the CMS is not proposing to add to the list after the PHE ends. The CMS acknowledges that a more permanent extension of telehealth coverage will need to come from Congress.
The CMS solicits feedback on which of the waivers and flexibilities enacted during the PHE should be made permanent, including the supervision of residents by a teaching physician via real-time audio and video technology. The CMS proposes that it be permitted through Dec. 31, 2021, and is seeking comments on guardrails and whether this should be considered beyond 2021.
The CMS also proposes changes to the Medicare Shared Savings Program (MSSP) for performance year 2021 to align with Meaningful Measures, reduce reporting burden, and focus on patient outcomes. For performance year 2020, the CMS proposes to provide automatic full credit for Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience of care surveys. The CMS seeks comment on an alternative scoring methodology approach under the extreme and uncontrollable circumstances policy for performance year 2020.
Quality Payment Program
In the Quality Payment Program section of the rule, the CMS proposes significant changes to reporting and participation options for providers in the program.
The CMS proposes changes to Merit-based Incentive Payment System (MIPS) performance thresholds and category weights at the following levels for the 2021 performance year (2023 payment year):
- Performance threshold: 50 points (decrease from 60 points finalized in CY 2020 Physician Fee Schedule final rule).
- Quality performance category weighted at 40% (decrease from 45% in performance year 2020).
- Cost performance category weighted at 20% (increase from 15% in performance year 2020).
- Promoting Interoperability performance category weighted at 25% (no change from performance year 2020).
- Improvement Activities performance category weighted at 15% (no change from performance year 2020).
By statute, the Cost and Quality performance categories must be equally weighted at 30% beginning in 2022 performance period.
In light of the COVID-19 PHE, the CMS will not be introducing any MIPS Value Pathways (MVPs), as finalized in the 2020 Medicare Physician Fee Schedule final rule, for the 2021 performance year. However, the CMS proposes additions to the MVP framework, including the addition of a subgroup reporting option and a fifth principle of MVP to promote digital performance measure submission.
For performance year 2021, the CMS proposes a new Alternative Payment Model Performance Pathway (APP) to align with the new MVP framework. This option would only be available to MIPS Alternative Payment Model (APM) participants and would be reported by the individual eligible clinician, group at the Taxpayer Identification Number (TIN) level, or APM entity. The CMS also proposes to sunset the CMS Web Interface as a collection type beginning in the 2021 performance year and to end the APM Scoring Standard for the 2021 performance year.
The CMS issued a Physician Fee Schedule fact sheet and a Quality Payment Program fact sheet along with the proposed rule. The AAMC is reviewing the provisions in the proposed rule and will be providing more details in a webinar soon. Comments are due Oct. 5, 2020.