Family Physicians, Geriatricians Could See 30% Medicare Increases
Written by Editor   
Friday, July 22, 2016 12:00 AM

Primary care is the watchword for 2017 when it comes to the Medicare physician fee schedule proposed by the Centers for Medicare & Medicaid Services (CMS).

“In the United States, we have historically invested far more in treating sickness than we do in maintaining health," CMS acting administrator Andy Slavitt said. “The result of this imbalance is not only poorer health, but more money spent in institutions, hospitals, and nursing homes. The road to a better health care system means correcting this imbalance," he continued. "We should reinvest in what we value."

Under the proposed rule, Medicare would:

  • Increase primary care provider payments for routine office visits involving patients with mobility-related disabilities, raising the payment from $73 to $119 per visit.

  • Increase payments to geriatricians and family physicians. "We anticipate that these clinicians could receive a 2% increase in their payments for providing the care we propose to recognize under the Physician Fee Schedule," Slavitt said. "Over time, if all of the practitioners that can provide these services provide them to all eligible patients, we estimate that the payment increase could be as much as 30% and 37%, respectively, to these specialties."

Diabetes prevention was another big focus in the proposed fee schedule. CMS is proposing to expand the Diabetes Prevention Program into Medicare starting in 2018. The program “is a structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic," CMS explained. It consists of 16 intensive group educational sessions succeeded by less-intensive monthly follow-up meetings.

Not everyone was happy with the proposed regulation. The director of the Washington office of the American Association of Neurological Surgeons (AANS), said that based on her quick read of the rule, AANS is “extremely disappointed” in CMS’s proposed strategy of data collection for its global surgery code.  “CMS believes that right now surgeons are getting overpaid for their global surgery services, because either they're not performing the number of post-operative visits built into the reimbursement, or they're doing the surgery but another physician may be doing the post-operative work."

A few years ago, CMS suggested eliminating global surgery codes and instead require surgeons to submit a claim for surgery and then an additional claim for every visit after a procedure within the 10-to-90-day global surgery code period. Congress prevented that from happening via MACRA, but instead the agency was directed to collect data to better understand the value of the services surgeons were providing and what effect unbundling global codes might have.