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Medicare Proposes 2020 Physician Payment Policies

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July 31, 2019

Medicare Proposes 2020 Physician Payment Policies

Telehealth, bundled payment, and extra reimbursement for treating chronic conditions are among the key topics addressed by the Centers for Medicare & Medicaid Services (CMS) in its recent proposal for updating physician payment rates and policies for Calendar Year 2020.

CMS is accepting comments on the proposal until September 27, 2019, and is expected to release a final rule in November.

Highlights:

Bundled Payment: CMS is proposing a monthly bundled payment for management and counseling for opioid use disorder. It would cover overall management, care coordination, individual and group psychotherapy, and substance-use counseling.

Telehealth: CMS says opioid treatment practices can use telehealth to provide this kind of care management and counseling that is included in the payment bundle. The agency says telehealth will increase access for beneficiaries, especially in rural areas or those with a shortage of clinicians.

Care Management: CMS is proposing increased payment for the time clinicians spend on care management for various types of chronically ill patients: those transitioning from the hospital to their homes; those with a single, high-risk chronic condition, such as diabetes; or those who have multiple chronic conditions.

Patient Evaluation: CMS says it intends to pay more across all specialties for the time clinicians spend evaluating and treating patients with greater clinical needs and multiple medical conditions.

Pay-for-Performance: CMS is proposing to simplify the way clinicians can participate in the Merit-Based Incentive Payment program (MIPS)—one of main methods CMS uses in updating physician payment based on the clinician’s quality performance. CMS would allow physicians, starting in 2021, to report their performance on a smaller set of measures that are specialty-specific and outcomes-based.