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Provider groups are not happy with the payment adjustment included — a 3.75% reduction to the conversion factor due to budget neutrality requirements — and will likely seek congressional intervention.

CMS is proposing to extend Medicare coverage of certain telehealth services granted for the COVID-19 public health emergency to the end of 2023 to help gather data that can determine whether the services should be permanently covered.

The agency similarly suggested allowing for some mental healthcare to be provided on an audio-only basis going forward in the proposed Physician Fee Schedule for 2022, released Tuesday. The annual rulemaking also includes changes to the Quality Payment Program and seeks feedback on how to improve data gathering from providers in an effort to better health equity.

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“Over the past year, the public health emergency has highlighted the disparities in the U.S. health care system, while at the same time demonstrating the positive impact of innovative policies to reduce these disparities,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “CMS aims to take the lessons learned during this time and move forward toward a system where no patient is left out and everyone has access to comprehensive quality health services.”

But provider groups were not happy with the payment adjustment included — a 3.75% reduction to the conversion factor, due to budget neutrality requirements. The Medical Group Management Association, which represents physician practices, said in a statement that it would seek congressional intervention to avoid the cut.

Industry lobbies were pleased, however, the proposed rule delays enforcement of the Appropriate Use Criteria program, which requires providers to use clinical decision support mechanisms when ordering certain advanced diagnostic imaging. 

The requirement was set to go into effect in January but has now been extended for a year. The American Hospital Association said the change, “will enable hospitals and other providers to maintain their ongoing response to the COVID-19 crisis while allowing essential education and operations testing of the AUC program to occur.”

Groups representing accountable care organizations, meanwhile, applauded another delay, wherein CMS proposed waiting on a transition in the Medicare Shared Savings Program to electronic quality measure reporting.

The agency said in a fact sheet on the PFS that the temporary extension of Medicare telehealth coverage is meant to serve as a “glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE.”

Lawmakers, patient advocates and many industry groups have said they support permanently adding many of the services to the coverage list, but CMS said it wants more information on their efficacy. The agency declined some proposals for permanent coverage as not meeting the criteria on the books.

“We view the draft rule as a modest positive for telehealth stakeholders; however, we continue to believe bigger impact changes will require additional legislation,” Cowen analysts wrote in a Tuesday note on the rule.

Telehealth use has declined as people have received vaccinations and felt more comfortable going into a doctors office, but visit rates are still much higher than before the pandemic. Most stakeholders expect that to hold.

The rule would put into effect a law that removes geographic restrictions for diagnosis, evaluation or treatment of a mental health disorder and allows a patient’s home to serve as an originating site for a telehealth visit. It places some restrictions, however, including a requirement that the patient had an in-person visit some time within six months before the virtual visit. 

Patient advocates and some providers may see this as too restrictive, citing the potential loss of access to care.

The proposed overhaul of the QPP includes the introduction of Merit-based Incentive Payment System Value Pathways for the 2023 MIPS performance year and the end of traditional MIPS at the end of the 2027 performance year.

Also, subgroup reporting would be allowed in an effort to provide “more comprehensive and granular” data sets. And clinical social workers and certified nurse-midwives would be added to the list of clinicians eligible for the program.

The initial set of MVP clinical areas would be: rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair (e.g., knee replacement), emergency medicine and anesthesia. 

CMS said the changes should allow clinicians to see “greater returns on their investment in the program as we see higher payment adjustments as well as begin to see a more equitable distribution within our scoring system and small practices no longer bearing the greatest share of the negative payment adjustments.”

For health equity data collection, CMS could give providers confidential reports with data points including race, disability, rural populations and LGBT status. This information would support initiatives to close equity gaps and allow providers to identify disparities, the agency said.

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