CMS Releases Proposed Rule on Medicare Primary Care Payment and Indicates Flexibility on Prescription Drug Proposal

The Centers for Medicare and Medicaid Services (CMS) has released the Medicare Physician Fee Schedule Proposed Rule, which could transform how Medicare pays for primary care for patients with multiple chronic conditions, mental and behavioral health conditions, cognitive impairment and mobility-related impairments. The proposed rule is particularly important for dually eligible individuals, who are more likely to suffer from such conditions. The comment deadline for the proposed rule is Sept. 6. In the rule, CMS is proposing additional payments to physicians for:

  • the time and equipment needed to serve beneficiaries with mobility-related impairments,
  • the work primary care physicians do with behavioral health professionals to improve care for patients with behavioral health conditions,
  • cognitive care assessment and care planning, and
  • chronic care management that occurs outside of an office visit.

In other rulemaking news, CMS has indicated that it is planning to make changes to its controversial proposal to reduce Medicare payments for many prescription drugs. The proposed rule has drawn fire from both Democrats and Republicans in the U.S. Senate. CMS insists, however, that while changes to the proposal will be made, the status quo is unsustainably expensive for enrollees.

ACOs Demonstrate Modest Cost Savings for Medicare Enrollees

The Commonwealth Fund has released a study looking at the effect of Accountable Care Organizations (ACOs) on health care use and spending among Medicare beneficiaries. The study found cost savings of 1.3 percent among Medicare beneficiaries as a whole, and savings of 2 percent among beneficiaries with at least three chronic or acute conditions. The results suggest that the ACO model produces modest early benefits in emergency department and hospital use, as well as reductions in overall spending. The study did not address quality of care or health outcomes among beneficiaries.

Shortage of Geriatricians Becoming More Acute

Across the United States, there are 130 geriatric fellowship programs with 383 positions. However, in 2016, only 192 of those positions were filled. As the country’s population ages, the shortage of trained geriatricians is becoming more and more acute with medical students, who often carry high student loan debt, shunning geriatrics for more lucrative specialties. The disconnect between the number of trained geriatricians and the rapidly increasing need for these specialists in the U.S. is only expected to get worse in the coming decades as our aging population grows.