Payment Rule Updates Mixed Bag for Docs

John Commins, November 9, 2017

Although CMS sought to improve flexibility and simplicity for physicians, a physician advocacy group says the results are mixed and that more work needs to be done.

Matthew Katz
Matthew Katz

The Medicare Quality Payment Program final regulation for 2018 is getting mixed reviews from the Physicians Advocacy Institute.

In what could prove to be time-consuming nightmare, the 2018 reporting year will require physicians to submit a full 12 months of data, instead of the three months required in 2017, according to PAI board member Matthew Katz, who is also CEO of the Connecticut State Medical Society.

Katz spoke with HealthLeaders Media about the rules change. The following is a lightly edited transcript.  

HLM: What do you like about the final rule for 2018?

Katz:  Let’s put aside whether we like the program itself. When it comes to the changes that came in, PAI appreciates the addition of some exemptions for the smaller practices. This final rule expanded those exemptions to cover more small practices; those that have low volumes of Medicare patients, or low dollar amounts when it comes to the amount of care they provide for Medicare beneficiaries.

It does not punish physicians who are stuck with electronic medical records vendors who have not been able to update their programs. CMS’s previous approach was going to be you had to be 2015 CEHRT certified. A lot of smaller practices purchased EMRs a few years ago with the understanding that those EMR companies were going to update their systems. They never did. The doctors were going to be punished if CMS didn’t make some changes. So, they’re allowing the 2014 or 2015 CEHRT, and giving bonuses for 2015 because it doesn’t punish doctors whose EMR vendors have not been able to adhere to the requirements.

There is also some progress in the episode-based measures they’ve come up with. We would like to see that expanded. They are providing some additional bonuses to small practices, which is good. And, they are focusing more on complex patients and providing bonuses for better care for dual-eligible patients. We think that is good.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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