CMS Finalizes 2019 PFS and QPP Rule

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) finalized the 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule. 

“We are pleased that CMS addressed several of our concerns with the proposed rule, particularly those related to delaying the implementation of the E/M coding changes and not cutting reimbursement for the modifier-25,” said CEO of the OSMA Todd Baker. “We appreciate the work individual practices in Ohio did in submitting comments, and we thank Senator Brown and other members of the Ohio congressional delegation for forcefully letting CMS know the detrimental impact the proposed rule would have on many of Ohio's smallest medical practices."

CMS Press Release
AMA Statement

AMA: Three Things Physicians Should Know

CMS Press Release 
AMA Statement
AMA: Three Things Physicians Should Know

“The rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” said CMS Administrator Seema Verma. “[It also] offers immediate relief from onerous requirements that contribute to burnout in the medical profession and detract from patient care.”

The final rule updates some policies under Medicare’s accountable care organization (ACO) program that streamline quality measures to reduce burden and encourage better health outcomes, although broader reforms to Medicare’s ACO program were proposed in a separate rule. This rule is projected to save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade.

“Among other advances, improving how CMS pays for drugs and for physician visits will help deliver on two HHS priorities: bringing down the cost of prescription drugs and creating a value-based healthcare system that empowers patients and providers,” said Health and Human Services (HHS) Secretary Alex Azar.

Effective January 1, 2019, payment amounts for new drugs under Part B will be reduced, decreasing the amount seniors have to pay out-of-pocket, especially for drugs with high launch prices.

The final rule will also provide access to “virtual” care, paying providers for new technology-based services, such as brief check-ins between patients and practitioners, and pay separately for evaluation of remote pre-recorded images and/or video. CMS is also expanding the list of Medicare-covered telehealth services. This will give seniors more choice and improved access to care.

E/M Coding

Coding requirements for physician services known as “evaluation and management” (E&M) visits have not been updated in 20 years. This final rule addresses longstanding issues and also responds to concerns raised by commenters on the proposed rule. 

CMS is finalizing several burden-reduction proposals immediately (effective January 1, 2019), where commenters provided overwhelming support. In response to concerns raised on the proposal, the final rule includes revisions that preserve access to care for complex patients, equalize certain payments for primary and specialty care, and allow for continued stakeholder engagement by delaying implementation of E&M coding reforms until 2021.

CMS is also finalizing an overhaul of electronic health record (EHR) requirements in order to focus on promoting interoperability. The rule finalized changes to help make EHR tools that actually support efficient care instead of hindering care. 

Final policies for Year 3 of the Quality Payment Program, part of the agency’s implementation of MACRA, will advance CMS’s Meaningful Measures initiative while reducing clinician burden, ensuring a focus on outcomes, and promoting interoperability. 

> View the CY 2019 Physician Fee Schedule and Quality Payment Program final rule

> Fact sheet on the CY 2019 Physician Fee Schedule final rule

> Fact sheet on the CY 2019 Quality Payment Program final rule

> Chart on E&M payment amounts

> Read the full press release from CMS