Understanding the 2018 Medicare Physician Fee Schedule
Medicare is a crucial part of the healthcare system in the United States, providing coverage for millions of individuals who are 65 and older, as well as certain younger people with disabilities. The Medicare Physician Fee Schedule (MPFS) is an important component of Medicare, as it determines the amount Medicare will pay for physician services. In 2018, there were several updates and changes to the Medicare Physician Fee Schedule that both physicians and patients should be aware of.
Background of the Medicare Physician Fee Schedule
The Medicare Physician Fee Schedule was established by the Balanced Budget Act of 1997 and is updated annually by the Centers for Medicare & Medicaid Services (CMS). The MPFS assigns relative values to each medical service or procedure based on the resources required to provide that service. These values are then adjusted for geographic location to account for differences in the cost of providing care in different areas of the country.
Medicare pays physicians based on these relative values, which are multiplied by a conversion factor to determine the actual payment amount. The conversion factor is updated each year to account for changes in the overall cost of providing healthcare services.
Changes to the 2018 Medicare Physician Fee Schedule
Updates to Payment Rates
One of the key changes to the 2018 Medicare Physician Fee Schedule was the update to payment rates for physician services. The conversion factor for 2018 was set at $35.99, an increase from the 2017 conversion factor of $35.89. This slight increase in the conversion factor resulted in a 0.5% increase in payment rates for most services.
Changes to Evaluation and Management Codes
Another significant change to the 2018 Medicare Physician Fee Schedule was the restructuring of evaluation and management (E/M) codes. CMS finalized a proposal to collapse payment rates for E/M office visits for new patients into a single payment rate, as well as a single payment rate for E/M office visits for established patients.
This change was intended to simplify the payment rates for E/M services and reduce administrative burden on physicians. However, some physician groups expressed concern that the new payment rates were not accurately reflective of the resources required to provide different levels of E/M services.
Telehealth Services
Telehealth services continue to be an important area of focus for CMS, as they have the potential to increase access to care for patients in underserved areas. In 2018, CMS added several new telehealth services to the list of Medicare-covered services, including psychotherapy services, prolonged evaluation and management services, and interactive complexity services.
These changes are part of CMS's ongoing efforts to expand access to telehealth services and ensure that patients in rural and underserved areas have access to high-quality care.
Quality Payment Program
The Quality Payment Program (QPP) is a key component of the Medicare Access and CHIP Reauthorization Act (MACRA), which aims to shift Medicare payments from fee-for-service to value-based care. In 2018, CMS continued to implement the QPP by evaluating physician performance based on two tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
Physicians who participate in MIPS are measured on several performance categories, including quality, cost, improvement activities, and promoting interoperability. Those who participate in Advanced APMs are eligible for a 5% incentive payment and are exempt from MIPS reporting requirements.
Impact of the 2018 Medicare Physician Fee Schedule
Positive Impacts
- Increased payment rates for most services
- Expansion of telehealth services
- Streamlined payment rates for E/M services
Negative Impacts
- Concerns about accuracy of E/M payment rates
- Potential administrative burden for physicians
- Challenges in meeting QPP performance requirements
Overall, the 2018 Medicare Physician Fee Schedule had both positive and negative impacts on physicians and patients. While the increase in payment rates and expansion of telehealth services were positive developments, concerns about the accuracy of E/M payment rates and challenges in meeting QPP performance requirements remain areas of concern.
Conclusion
The 2018 Medicare Physician Fee Schedule brought several changes and updates to the payment rates and policies governing physician services under Medicare. Physicians and patients should be aware of these changes and how they may impact the delivery of care and access to services. As the healthcare landscape continues to evolve, staying informed about Medicare policies and payment schedules is essential for all healthcare stakeholders.
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