CMS proposes major Medicare physician payment overhaul to boost primary care
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The proposal is open for public comment before CMS issues a final rule.
What the proposal would change
- The proposal would update Medicare's Physician Fee Schedule, which is used to pay doctors and other clinicians for services provided to beneficiaries.
- CMS said the changes are intended to make payments more accurate by accounting for the time, resources and complexity involved in care.
- CMS also said it wants to increase transparency around how physician payment rates are calculated and strengthen oversight of billing practices in cases where claims may not accurately reflect services provided.
- The agency said the changes would move Medicare away from paying mainly for the volume of services and toward rewarding better outcomes for patients.
Primary care, reporting and bonus payments
- "We're proposing some of the most significant Medicare reforms in recent years to strengthen primary care, expand accountable care, and modernize physician payment," CMS Administrator Dr. Mehmet Oz said in the announcement.
- The proposed physician payment changes are designed to support primary care, preventive services and better coordination for people covered by Medicare, CMS said.
- CMS said it would end traditional Merit-based Incentive Payment System (MIPS) reporting in 2029 and move clinicians toward more specialty-focused reporting pathways.
- The agency also proposed new reporting options for doctors who treat diabetes, high blood pressure and hospital patients.
- The change would stop $2.38 billion in bonus payments from going to clinicians who are not in advanced value-based care programs, the agency said.
