Physician Fee Schedule: A Closer Look

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The Centers for Medicare & Medicaid Services (CMS) issued the Notice of Proposed Rulemaking for the 2016 Physician Fee Schedule on July 15. Among other changes, CMS proposes new codes and payment levels for Advance Care Planning; requests comments for future implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); and estimates a 0% aggregate change in reimbursement for medical oncology services and a 3% reduction for radiation oncology services. ASCO is working to examine all of the provisions of the notice and the impact on oncologists.

The proposal of Advance Care Planning (ACP) will cover two advance care planning services provided to Medicare beneficiaries by physicians or other practitioners. Previously, these services were only available as part of the “Welcome to Medicare” initial visit, but the proposal would promote access to advance care planning services by providing separate payment and more flexibility in timing. Payment policies that allow patients and oncologists to have conversations and share information needed to make informed choices throughout the course of an illness are essential to promoting high-quality, high-value care.

MACRA replaced the Sustainable Growth Rate (SGR) formula for fee adjustments and establishes a Merit-Based Incentive Payment System (MIPS) that offers performance improvement incentive payments beginning in 2019. To help with implementation, CMS is seeking input on various provisions of MACRA, including implementation of MIPS and alternative payment models. Additionally, CMS proposes to implement provisions included in MACRA that would allow group reporting of quality measures to a qualified clinical data registry.

Finally, while CMS estimates that the overall reimbursement impact for medical oncology and hematology will be 0% in 2016, CMS estimates that the proposed rule will result in a 3% cut for radiation oncology. ASCO is analyzing the various issues that are contributing to the overall reduction, and remains concerned that these cuts could have adverse effects on patient access to medically necessary care. ASCO is examining these and other issues of importance to ASCO members and the oncology community and will be providing comments to CMS by the September 8, 2015, deadline.

Radiation oncology has suffered significant cuts over the past three fee schedules, so ASCO will pay special attention to better understanding that dynamic. ■




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