Doctors could be paid more in 2017 for care coordination, preventive care, and mental/behavioral health care services.
The Centers for Medicare & Medicaid Services plans to spend an extra $140 million on these services next year under the final physician fee schedule, released on Nov. 2 and scheduled for publication in the Federal Register on Nov. 15.
Over time, spending on these services could reach $4 billion, according to a Nov. 2 blog post by CMS Acting Administrator Andy Slavitt and Acting Principal Deputy Administrator and Chief Medical Officer Patrick Conway, MD .
“Clinicians will additionally be able to bill and be paid more appropriately when they spend more time with their patients, serving their patients’ needs outside of the office visit, and better coordinate care,” they wrote.
CMS finalized a number of payment codes that “better identify and value primary care, care management, and cognitive services,” according to an agency fact sheet highlighting key provisions of the final physician fee schedule for 2017.
The coding changes allow for separate payments for non–face-to-face prolonged evaluation and management services; revalue existing codes for face-to-face prolonged services; separate payments for comprehensive assessment and care planning for patients with cognitive impairments such as dementia; and separate payments for chronic care management of complex patients.
“This final decision by CMS means individuals living with Alzheimer’s disease will finally have access to critical care and support services that can improve quality of life for the individual, their family, and caregivers,” Harry Johns , Alzheimer’s Association President and CEO, said in a statement. “Now that care-planning sessions will be available to them, individuals living with the disease will have access to much-needed information on treatments and services.”
When it comes to behavioral care management, CMS will now make separate payments to primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions, including care coordination between a psychiatric consultant or behavioral health specialist, behavioral health care manager, and the primary care clinician.
“Geriatricians, internists, and family physicians provide core services for the Medicare program, including the kinds of care management and patient-centered care that are described by these new codes,” Mr. Slavitt and Dr. Conway wrote. “Over time, we estimate that the payment increases attributable to these new codes could be as much as 30% and 37%, respectively, to these specialties.”
CMS also finalized other coding changes, including:
The American College of Physicians applauded the final rule.
“The policies in the rule more accurately recognize the work of primary care physicians and other cognitive specialties to accommodate the changing needs of Medicare beneficiaries,” ACP President Nitin S. Damle, MD , said in a statement.
