by Karl Steinberg, MD, CMD, HMDC

On April 27, 2016, CMS released the long-awaited proposed rule--now in its comment period--that shows the roadmap of where physician and NPP (non-physician practitioner) reimbursement is heading under Medicare B. The document is almost 1000 pages long, but in it are some important wins for post-acute and long-term care (PA/LTC) clinicians.  Much more information will be forthcoming, but a couple of positive developments are that (1) for clinicians who make more than 50% of their Medicare visits in a facility where there is no certified EHR technology (CEHRT) and the clinician has no control over that, there will be no penalty for not achieving Meaningful Use, as long as the clinician completes an application or attestation to that effect; and (2) for the purposes of resource utilization, no visits performed in place of service (POS) 31--which is skilled nursing facility, as in skilled/rehab, not custodial--will be counted “against” a physician as far as primary care duties.  

This is important because these patients are high utilizers because of the acuity of their condition and their many comorbidities.  Both of these items are specific areas that AMDA--The Society for Post-Acute and Long-Term Care Medicine requested in previous comment letters to CMS.  So, it appears that CMS, thankfully, is listening to us.  

For our clinicians, we should be mindful to bill the correct place of service codes:  31 for skilled, 32 for custodial nursing home visits.  And there are many nuances that have yet to be worked out:  MIPS (Merit-Based Incentive Payment System) may be difficult for some small-group or solo practitioners to operationalize, hence they may be penalized (or rewarded)--up to 4% initially, but eventually up to 9% of their total Medicare billings; versus APMs (Alternative Payment Models) that require some downside risk on the part of the medical group.  However, eligible clinicians who participate in Advanced APMs will get an across-the-board 5% bonus.  On balance, it may prove simpler for some clinicians to join forces with large groups to get this benefit.  More will be revealed!  But in the meantime, let’s thank CMS for at least considering the concerns of our constituency… and not further disincentivizing our decision to provide care to this vulnerable and complex population!

AMDA’s initial posting on this recent development, along with some useful links, can be found at http://www.paltc.org/publications/macra-proposed-rule-released-victories-paltc-professionals.