WASHINGTON -- Payments to physicians who treat Medicare patients will increase 0.41% in 2018, the Centers for Medicare & Medicaid Services (CMS) announced Thursday.
"This update reflects the +0.50% update established under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, reduced by 0.09% due to the misvalued code target recapture amount," the agency noted in a . The misvalued code target recapture amount refers to reductions in payments to account for misvalued reimbursement codes.
The final conversion factor for the fee schedule -- the amount that Medicare's relative value units are multiplied by to arrive at a reimbursement for a particular service or procedure -- is $35.99, up from $35.89 in 2017.
The agency noted several other changes for next year, including:
- The addition of several new telehealth codes, including those for a health risk assessment and for psychotherapy in a crisis situation.
- Separate codes and payments for biosimilar products paid for under Medicare Part B. "Effective Jan. 1, 2018, newly approved biosimilar biological products with a common reference product will no longer be grouped into the same billing code," the agency said.
- A 20% reduction in payments for some services performed at off-campus hospital outpatient departments. "CMS believes that this adjustment will provide a more level playing field for competition between hospitals and physician practices by promoting greater payment alignment," the agency said.
The agency is also deferring until 2020 the start of a new Appropriate Use Criteria (AUC) rule regarding diagnostic imaging. "The program will begin in a manner that allows practitioners more time to focus on and adjust to the Quality Payment Program before being required to participate in the AUC program," the agency said, noting that the first year of the program will be "educational and operations testing ... which means physicians would be required to start using AUCs and reporting this information on their claims. During this first year, CMS is proposing to pay claims for advanced diagnostic imaging services regardless of whether they correctly contain information on the required AUC consultation. This allows both clinicians and the agency to prepare for this new program."
The American College of Cardiology (ACC) praised the AUC decision. "The College hopes that CMS will continue to work with stakeholders to ensure that the AUC program supports improved, cost-effective patient care without excessively burdensome requirements," ACC President Mary Norine Walsh, MD, said in a statement. "The ACC is committed to the use of AUC in clinical decision-making and is pleased to see that CMS is providing additional time to prepare for this program."
The American College of Emergency Physicians (ACEP) also supported the delay in a letter sent in September to CMS. "Implementation of the Merit-Based Incentive Payment System (MIPS) in 2017, and further expansion of its transition year requirements in 2018, provides an overwhelming number of challenges to physicians and CMS should be doing everything possible to minimize any additional burdens over the coming year," wrote ACEP president Rebecca Parker, MD.
CMS also said that based on public comments, the agency decided against updating its malpractice relative value units for 2018. "Additionally, we are not finalizing our proposal to align the update of malpractice premium data with the malpractice geographic practice cost index updates, which has been done once every 3 years, at this time. In principle, we continue to believe that more frequent updates are optimal, and we will consider this in future rulemaking."