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CMS Updates Fee Schedule, Encouraging More Doctor-Patient Face Time

by Elizabeth Hofheinz, M.P.H., M.Ed., November 8, 2019

The “math” is pretty straightforward: If a patient thinks a doctor doesn’t care about them, then they are not going to be very satisfied. And nothing says, ‘I care’ like giving your time to someone.

In line with the trend towards social determinants of health (SDOH), CMS has just finalized new rules that update existing education and management codes, with an emphasis on encouraging clinicians to spend more time on care coordination.

A recent article in Modern Healthcare, (“CMS is changing how it pays doctors to coordinate care,” Michael Brady, November 1, 20191) addresses the change, stating, “The rule finalized increases in the importance of cost performance under the Merit-Based Incentive Payment System, which ties Medicare Part B payments to clinician quality and cost-effectiveness. It’s supposed to promote clinicians’ transition to value-based payments, which reward physicians for outcomes instead of the volume of services provided.”

“Physician groups have complained that too many doctors are left out of MIPS and that it’s too easy to get bonuses. They also worry that the penalties for not delivering on quality or cost performance aren’t big enough to encourage improvement.”

CMS Administrator Seema Verma was quoted as saying, “We want to focus on the time that providers are spending with patients. We know that some of these visits have become more complex.”

There is little hope of unraveling the tangled web of living environment, education level, etc.—SDOH—without taking a strategic approach.

One example is a recent announcement by CMS’ Innovation Center of a 5-year, $157 million program to pilot Accountable Health Communities (AHC). The goal is to determine whether “systematically identifying and addressing health-related social needs can reduce health care costs and utilization among community-dwelling Medicare and Medicaid beneficiaries.”2

In the aforementioned Modern Healthcare article, Seema Verma mentioned CMS’ “growing desire to address social determinants of health (SDOH) to better coordinate care, improve health outcomes and cut spending.”

She added that the reimbursement rates in the 2020 physician fee schedule would not be in effect until 2021, so doctors and hospitals should consider them “preliminary.”

Commenting on the new CMS changes was Chris Stewart, COO and General Manager of Hospital and ASC Strategy at Ortho Spine Partners, who told OSN, “Hopefully this will allow physicians to spend more time with their patients and manage their episodes of care versus today’s administrative burden of paperwork and complex billing and coding, which often leads to burnout.”



  1. https://www.modernhealthcare.com/payment/cms-changing-how-it-pays-doctors-coordinate-care
  2. http://www.livewellsd.org/content/dam/livewell/pdfs/AHC%20NEJM%20Sanghavi%20et%20al.pdf

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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