Regulations Finalized for 2015 Medicare Fee Schedule and Hospital Outpatient Services In October, the Centers for Medicare and Medicaid Services (CMS) released two final regulations of note to cardiovascular professionals. These rules determine the payment levels and associated policies for services provided under the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System. The rules indicate that physicians will see no change in payment for the first three months of 2015 due to the latest Sustainable Growth Rate (SGR) patch. However, the SGR will take effect April 1, 2015, unless Congress again intervenes. At that time physicians would face a 21.2 percent cut as a result of the legally mandated SGR. Hospitals will receive a 2.3 percent increase in payment. The ACC continues to urge Congress to permanently address this issue. Changes unrelated to the SGR result in a flat payment for services provided by cardiologists in 2015. This estimate is based on the entire universe of cardiology services and can vary widely depending on the mix of services provided in a practice. Some of the other most important proposals for cardiology contained in the rules include: Physician Fee Schedule » For satisfactory Physician Quality Reporting System (PQRS) participation, eligible professionals or groups must report at least nine measures across three domains for at least 50 percent of the professional’s Medicare Part B fee-for-service patients. At least one of these measures must be from the crosscutting measure set CMS is introducing for 2015. Failure to meet the 2015 reporting requirements will result in a -2.0 payment adjustment in 2017. » The value-based modifier (VBM) will apply to all physician and non-physician eligible professionals in 2017 based on reporting in 2015. The maximum -4 percent VBM payment adjustment will only apply to groups of 10 or more eligible professionals subject to the VBM that do not meet PQRS reporting requirements. Solo practitioners and groups of two to nine eligible professionals will be subject to a maximum payment adjustment of -2 percent for failure to meet the reporting requirements. » Under the VBM quality-tiering methodology, CMS will set a maximum bonus or penalty of up to 4 percent of payment for groups of 10 or more eligible professionals based on quality and cost of care classification. Solo practitioners will be eligible for a bonus of up to 2 percent and will not be subject to any penalties based on quality and cost classification. » Physicians who provide transesophageal echocardiography (TEE) guidance during structural heart interventions can now report CPT code 93355 with a work value that more appropriately captures the required physician work. The entire family of TEE codes was also reviewed and is slated for modest increases in physician work on an interim-final basis. » CMS is not finalizing its proposal to review high expenditure codes, including SPECT-MPI, TTE, stress echo, and electrophysciology device programming. However, CMS maintains its belief that a high expenditure screen may useful to identify misvalued codes in the future. » CMS will transition all 10- and 90-day global period codes to 0-day global periods starting in calendar year 2017. » Non-face-to-face chronic care management services provided to patients who have multiple, significant, chronic conditions can be reported using code 99490 up to once per calendar month per qualified patient in 2015. » CMS removed the exception in the Physician Payment Sunshine Act (Open Payments Program) for reporting of indirect payments by industry to physicians serving as faculty for accredited and/ or certified continuing medical education. Hospital Outpatient Prospective Payment System » 25 of the 28 proposed Comprehensive Ambulatory Payment Classifications (APCs) have been finalized for 2015. Services assigned to the comprehensive APCs will be defined as primary services, with payment for all other services reported under a single hospital stay packaged under the primary service. Comprehensive APCs include automatic implantable cardiac defibrillator, pacemaker and related device procedures; electrophysiologic procedures; and endovascular procedures. » CMS will conditionally package all ancillary services assigned to APCs with a geometric mean cost of $100 or less into payment for a primary procedure, unless these services are performed by themselves. This includes electrocardiograms/ cardiography and chest X-ray procedures. » CMS will begin collecting data on services provided in off-campus provider-based outpatient departments. Services furnished in this setting will be reported with a Healthcare Common Procedural Coding System (HCPCS) modifier on a voluntary basis for one year, beginning Jan. 1, 2015. Reporting the new HCPCS modifier will be mandatory Jan. 1, 2016. » The requirements for physician certification of inpatient admissions will only apply only to long-stay cases and costly outlier cases. CMS believes that in most cases, the admission order, medical record and notes contain sufficient information to support the medical necessity of an inpatient admission. Stay Ahead of Coding Changes! The final 2015 Medicare Physician Fee Schedule finalizes several changes to cardiovascular coding. Next year, cardiology will see new codes for a subcutaneous implanted defibrillator system. Additionally, new codes have been created for trancatheter mitral valve repair (TMVR) and a new transesophageal echocardiography code when performed with an intervention, such as TMVR. There is also development of a new family of extracorporeal membrane oxygenation codes and several revised CPT codes. The 2015 CPT Reference Guide for Cardiovascular Coding, prepared by cardiovascular experts, is designed to help cardiovascular specialists and staff efficiently and accurately report cardiovascular services and procedures. Ensure you navigate the upcoming coding changes correctly by ordering your copy at CardioSource.org/CPT. ACC Launches Hospital Profiles and Hospital Search Tool The ACC has launched a public-facing hospital database and search tool that enables patients to find and compare hospitals in their area based on the cardiac services they provide and important information related to the care they give. As of Aug. 27, all hospitals participating in the NCDR have a Hospital Profile on CardioSmart.org, the ACC’s patient education and empowerment website. Through these profiles, patients, caregivers and other stakeholders are able to search hospitals based on specific criteria (location, hospital name and services provided) and can learn about every participating hospital’s quality measurement efforts through the NCDR. The establishment of Hospital Profiles ensures that patients receive credible information about NCDR participating hospitals. Additionally, having a Hospital Profile is an opportunity for hospitals to showcase their quality efforts to patients and stakeholders. For more information, visit CardioSmart.org/FindaHospital. EHR Incentive Program Update The Centers for Medicare and Medicaid Services issued a final rule allowing health care providers more flexibility in how they use certified electronic health record (EHR) technology (CEHRT) to meet meaningful use requirements under the EHR Incentive Program reporting period for 2014. Under the final rule, eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs if they were not able to fully implement 2014 Edition CEHRT. All eligible professionals, eligible hospitals and critical access hospitals are required to use the 2014 Edition CEHRT for all of 2015. The rule also finalizes the extension of Meaningful Use Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012. Federal Readmission Penalties Kick-In To address the growing burden of hospital readmissions, the Affordable Care Act initiated penalties for poor performing hospitals with Medicare reimbursement cuts starting in 2012. On Oct. 1, when the 2015 Inpatient Prospective Payment System went into effect, the Centers for Medicare and Medicaid Services (CMS) reduced payments for 2,610 hospitals by as much as 3 percent due to their excessive readmission rates for patients with heart failure, acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease, and elective total hip arthroplasty and total knee arthroplasty. The penalized hospitals account for nearly 75 percent of facilities subject to payment reductions, and CMS expects the fines to reach $428 million over the course of the year. The ACC’s Hospital to Home (H2H) initiative helps hospitals and cardiovascular care providers reduce cardiovascular-related hospital readmissions, improve transitions of care and reduce the risk of federal penalties associated with high readmission rates. H2H focuses on three evidence-based areas for improvement: early follow-up, post-discharge medication management and patient recognition of signs and symptoms. All NCDR participating hospitals now have access to H2H and other quality initiatives through the Quality Improvement for Institutions program. Activate your account today at CVQuality.ACC.org. CMS Publishes First Sunshine Act Reports On Sept. 30, the Centers for Medicare and Medicaid Services (CMS) published the first set of reports for payments industry made to physicians and teaching hospitals from Aug. 1 through Dec. 31, 2013. The five months of data represent $3.5 billion in payments to approximately 546,000 individual physicians and 1,360 teaching hospitals. Early reports indicated that approximately one-third of reports would be withheld from publication at this time. According to CMS, these reports did not pass a data consistency check performed after the Agency received a report from a physician of co-mingled data. The problematic data will be returned to industry for correction and resubmission. Physicians and teaching hospitals will have the opportunity to review and dispute the data in 2015 at the same time they are reviewing their pre-publication reports based on 2014 data. The reports are available via three downloadable files (one on general payments, one for research payments and one for ownership interests) or a tool that allows for searches by individual record. ACC Members Hit the Hill to Advocate for CV Professionals and Patients A record number of cardiovascular professionals (nearly 400, including approximately 100 fellows in training and 80 cardiovascular team members) gathered in Washington, DC, in September for ACC’s 2014 Legislative Conference. This year’s conference centered on the many ways the ACC is leading the way in transforming care. Following an entertaining evening with political power couple Mary Matalin and James Carville, courtesy of the ACC Political Action Committee (ACCPAC), attendees got up-to-speed on the hot button issues facing health care providers and the health care system as a whole. ACC President Patrick T. O’Gara, MD, FACC, along with ACC Vice President Richard Chazal, MD, FACC, and Michael Lauer, MD, FACC, director of cardiovascular science at the National Heart, Lung, and Blood Institute, came together to discuss the latest in cardiovascular innovation and research. The ACC’s Advocacy team participated in a panel discussion focused on educating participants about likely health care priorities in Congress this year. Experts from across the cardiovascular spectrum shared their thoughts on everything from team-based care as the answer to the tsunami of chronic cardiac disease, to leadership development to the importance of advocacy. Conference participants also participated in a series of breakout sessions focused on state advocacy in action, Medicare implementation of appropriate use criteria, and how to effectively meet with members of Congress. Finally, Margaret Hamburg, MD, U.S. Food and Drug Administration (FDA) commissioner, discussed the FDA’s role in promoting health care quality and innovation, and Mark Miller, PhD, executive director of the Medicare Payment Advisory Commission (MedPAC), provided MedPAC’s perspective on opportunities to improve quality of care. After a day of education, ACC members headed to Capitol Hill to meet directly with their legislators. In nearly 300 meetings with legislators, ACC members shared examples of how the College is leading the transformation of care and urged Congress to work with the ACC to develop a quality driven health care system, ensure practice stability and secure the future of cardiovascular care. With a plethora of challenges facing health care providers, ACC members were able to provide first-hand perspectives of how decisions made in Washington, DC, impact practices and patients across the country. Hot topics on the Hill included sustainable growth rate repeal, in-office ancillary services exception preservation, increased research and graduate medical education funding, incentivizing the use of clinical data registries and improving access for Medicaid children with complex medical problems. While on the Hill, the ACC recognized two members of Congress for being health care champions. This year, the ACC President’s Awards for Distinguished Public Service were given to Reps. Tom Price, MD, (R-GA) and Lois Capps (D-CA). Although Legislative Conference has come and gone, the ACC will continue working with Congress and other key stakeholders to develop a health care system that puts patients first and rewards cardiovascular professionals for their commitment to quality, evidence-based care. Members can stay on top of advocacy activities and communicate with lawmakers throughout the year with the new ACC Advocacy Action mobile app available on iTunes or Google Play. For full coverage of the conference, visit Blog.CardioSource.org.
Published by American College of Cardiology. View All Articles.
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