Healthcare News & Insights

How the 2016 Physician Fee Schedule will affect health IT

The Centers for Medicare & Medicaid Services (CMS) has some big plans for providers that would change how they use health IT and earn incentives for cost and quality measures. 

Two doctors looking at computer screenThe agency recently released its proposed 2016 Physician Fee Schedule, which will impact several key areas including health IT and reimbursement.

This time around, providers can expect more requirements for their electronic health records (EHRs) and some added coverage for telehealth and end-of-life counseling.

Fee schedule IT changes

In its ongoing effort to improve interoperability among providers, the proposed rule requires providers to make care plan information available at all times and to share the materials electronically when possible and appropriate.

CMS is also requiring EHRs to have certain capabilities that better support data sharing and care coordination.

The agency is also proposing several changes to its telehealth coverage policy, including adding payments for:

  • end-stage renal disease counseling, and
  • extended patient observation

Additionally, CMS is adding nurse anesthetists to the list of approved telehealth providers for services like evaluation and management visits.

Unfortunately, the scope of this coverage is still somewhat limited as only patients in rural locations with restricted access to health care would be covered for these services.

CMS is also making adjustments to the Physician Quality Reporting System (PQRS), such as adding measures related to chronic care and preventive services. The PQRS is one of the incentive programs that will be rolled into the new Merit-based Incentive Payment System created by the law repealing the sustainable growth rate formula.

Other proposed changes

Interestingly, CMS is also proposing several changes to its physician compare website, adding green check marks next to providers who’ve earned incentives for cost and quality.

As more patients are using websites to find cost-efficient and high quality physicians, providers will want to pay closer attention to the feedback these sites offer — and the image it presents of your facility.

Additionally, CMS is creating a separate payment for advance care planning.

Although it hasn’t determined what rate providers would be paid, CMS is proposing coverage for having conversations with patients about their preferred type of care and other options when they approach the end of their life.

This can include discussions about creating a living will, whether or not to pursue an alternative treatment or when to enter hospice care.

CMS is also proposing two new codes to bill advance care planning: one for the initial half-hour spent discussing options or filling out the necessary forms, and another for each additional half hour.

Although the proposed rules offer facilities more opportunities to be paid for services and care quality improvements, the changes will likely mean hospitals will be spending more time adjusting their IT operations to meet the new EHR and incentive program requirements.

The agency will be accepting comments on the proposed rule through Sept. 8. One area that CMS wants providers to weigh in on is how best to pay for collaborative care consultations between primary care doctors and specialists.

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