By Blair Childs, senior vice president of public affairs, Premier
Premier and its members commend the Centers for Medicare & Medicaid Services (CMS) for allowing individual or small group practice clinicians to join virtual groups as a new channel to participate in the Merit-based Incentive Payment System (MIPS).
We are also encouraged that CMS indicated its intention to develop a demonstration project to examine how clinicians participating in Medicare Advantage (MA) alternative payment models can qualify for bonus payments. Nearly one-third of Medicare beneficiaries are enrolled in an MA plan. Many MA plans have engaged providers in innovative value-based contracts that are benefiting patients. This policy would level the playing field for clinicians in areas with high MA penetration.
However, Premier and its members are disappointed with CMS’s decision to cut payment rates for non-excepted, off-campus, provider-based hospital departments by an additional 10 percentage points, from 50 to 40 percent. Basing this decision on an evaluation of a single code is unjustified and fails to reflect the higher costs that these sites incur relative to freestanding physician offices. This decision will reverse momentum toward providing care across the continuum. At this transitional moment where the industry is moving from fee-for-service to value-based payment, this decision undermines the movement to provide care outside the walls of the hospital, potentially leading to increased Medicare spending.
— Blair Childs, senior vice president of public affairs, Premier