Log in to MyACC
Heart of Health Policy | 2019 Physician Fee Schedule At-A-Glance
The Centers for Medicare and Medicaid Services' (CMS) final 2019 Medicare Physician Fee Schedule (PFS) rule is expected to have little impact overall on cardiology payments from 2018 to 2019 based on initial analysis. In addition, CMS has altered or delayed until 2021 proposed changes to evaluation and management (E/M) payment following comments and advocacy efforts from the House of Medicine, including the ACC. While ACC Health Affairs Committee leaders and Advocacy staff examine the final rule with a fine-tooth comb, here's a high-level glimpse of the key takeaways for cardiology.
E/M Payment: CMS finalized changes to streamline E/M documentation for 2019, but the agency is not finalizing its proposal to apply a multiple-procedure payment reduction to separate E/M services furnished on the same day as a global procedure. CMS indicates an intent "to engage in further discussions with the public over the next several years to potentially further refine our policies for 2021." The ACC has heavily advocated for the simplification of E/M documentation requirements as part of the College's effort to reduce administrative burden.
Appropriate Use Criteria (AUC) Mandate: The rule continues implementation of the mandate requiring that clinicians consult AUC through a qualified clinical decision support mechanism (CDSM) starting Jan. 1, 2020, when ordering advanced imaging services (i.e., SPECT/PET MPI, CT and MR).
Quality Payment Program (QPP): The final rule includes updates to the QPP for the 2019 performance period. Clinicians and groups participating in the Merit-Based Incentive Payment System (MIPS) are subject to payment adjustments of up to +/- 7 percent in 2021. Advanced Alternative Payment Model (APM) participants remain eligible for a +5 percent lump sum bonus. Other specifics address MIPS category weights, performance thresholds and volume thresholds for exemptions. APM participation and thresholds are also addressed. Scan the QR code for more QPP details. Evaluating whether to participate in an APM? ACC's APM Framework can help serve as a guide. Learn more at ACC.org/APM.
Practice Expense: While finalizing a four-year phase-in of updated direct practice expense inputs based on a contracted analysis, CMS is overriding several specific inputs in response to stakeholder feedback. Of acute interest to echocardiographers, the pricing for the equipment in an ultrasound room will be maintained in 2019 rather than reduced by 60 to 65 percent.
New Codes: The rule implements final values for new codes describing leadless pacemaker services, subcutaneous quantitative cardiac rhythm monitor services (loop recorder), pulmonary wireless pressure sensor services and chronic care remote physiologic monitoring services. Updated values are finalized for external counterpulsation, coronary fractional flow reserve measurement, supervised exercise therapy for peripheral artery disease and cardiac output dilution studies.
ACC Advocacy staff continue to review both final rules to identify additional topics of interest to ACC members. More information will be forthcoming in the Advocate newsletter and on ACC.org. Additionally, the ACC's Cardiovascular Summit, taking place Feb. 14 to 16 in Orlando, FL, will provide unique opportunities to engage in discussions and learn from experts on how to put many elements of these rules into action.
HOPPS 101
On Nov. 2, the Centers for Medicare and Medicaid Services (CMS) released the final 2019 Hospital Outpatient Prospective Payment System (HOPPS) rule. Under the final rule, HOPPS payment rates will increase by 1.35 percent for 2019. The ACC formally commented on several provisions within the proposed HOPPS rule this summer. Scan the QR code for a closer look at the final rule in relation to these comments.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Heart Failure, Mechanical Circulatory Support, Computed Tomography, Nuclear Imaging, Exercise
Keywords: ACC Publications, Cardiology Magazine, Health Policy, Centers for Medicare and Medicaid Services, U.S., Motivation, Decision Support Systems, Clinical, Peripheral Arterial Disease, Outpatients, Area Under Curve, Medicare, Fee Schedules, Medicaid, Cardiac Output, Exercise Therapy, Prospective Payment System, Monitoring, Physiologic, Documentation, Counterpulsation, Tomography, Emission-Computed, Single-Photon, Pacemaker, Artificial, Tomography, X-Ray Computed
< Back to Listings
