BREAKING: Changes to Telehealth, Price Transparency, MIPS, All in CMS OPPS Final Rule
On Tuesday, Nov. 2, as it announced its calendar-year 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, the federal Centers for Medicare and Medicaid Services (CMS) made the announcement of elements contained in that rule that will impact its price transparency efforts and could lead to increased financial penalties for some hospital organizations.
A press release posted to CMS’s website began thus: “Today, the Centers for Medicare & Medicaid Services (CMS) is announcing actions that will advance its strategic commitment to drive innovation to support health equity and high quality, person-centered care. CMS’ Calendar Year (CY) 2022 Physician Fee Schedule (PFS) final rule will promote greater use of telehealth and other telecommunications technologies for providing behavioral health care services, encourage growth in the diabetes prevention program, and boost payment rates for vaccine administration. The final rule also advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes.
“Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future.”
Under the heading “Expanding Use of Telehealth and Other Telecommunications Technologies for Behavioral Health Care,” the press release went on to state that “The final rule makes significant strides in expanding access to behavioral health care ̶ especially for traditionally underserved communities ̶ by harnessing telehealth and other telecommunications technologies. In line with legislation enacted last year, CMS is eliminating geographic barriers and allowing patients in their homes to access telehealth services for diagnosis, evaluation, and treatment of mental health disorders.”
“The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are,” said Brooks-LaSure. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”
The press release went on to state that “CMS is bringing care directly into patients’ homes by providing certain mental and behavioral health services via audio-only telephone calls. This means counseling and therapy services, including treatment of substance use disorders and services provided through Opioid Treatment Programs, will be more readily available to individuals, especially in areas with poor broadband infrastructure. In addition, for the first time outside of the COVID-19 public health emergency (PHE), Medicare will pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via telecommunications technology, including audio-only telephone calls, expanding access for rural and other vulnerable populations.”
Price transparency
At the same time, in an email to the press, CMS stated on Tuesday that, “Beginning January 1, 2022, CMS will increase the penalty for some hospitals that do not comply with the Hospital Price Transparency final rule. Specifically, CMS is setting a minimum civil monetary penalty of $300 per day that will apply to smaller hospitals with a bed count of 30 or fewer, and a penalty of $10 per bed per day for hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500. Under this approach, for a full calendar year of noncompliance, the minimum total penalty amount would be $109,500 per hospital, and the maximum total penalty amount would be $2,007,500 per hospital. Hospital price transparency helps people know what a hospital charges for the items and services they provide, an important factor given that health care costs can cause significant financial burdens for consumers. While enforcement activities are necessary to drive compliance with price transparency, CMS is also committed to working with hospitals to help them meet those requirements,” the agency stated.
Meanwhile, the press release on the agency’s website, under the heading, “Advancing the Quality Payment Program and MIPS Value Pathways,” stated that, “To further improve the quality of care for people with Medicare, the PFS final rule makes several key changes to CMS’ Quality Payment Program (QPP), a value-based payment program that promotes the delivery of high-value care by clinicians through a combination of financial incentives and disincentives. For example, CMS finalized a higher performance threshold that clinicians will be required to exceed in 2022 to be eligible for positive payment incentives. This new threshold was determined in accordance with statutory requirements for the QPP’s Merit-based Incentive Payment System (MIPS).”
Further, “CMS is also moving forward with the next evolution of QPP and officially introducing the first seven MIPS Value Pathways (MVPs) ̶ subsets of connected and complementary measures and activities, established through rulemaking, that clinicians can report on to meet MIPS requirements. MVPs are designed to ensure more meaningful participation for clinicians and improved outcomes for patients by more effectively measuring and comparing performance within different clinician specialties and providing clinicians more meaningful feedback. This initial set of MVP clinical areas include: rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair (e.g., knee replacement), emergency medicine, and anesthesia. To incentivize high-quality care for professionals that are often a key point of contact for underserved communities with acute health care needs, CMS has also revised the current eligible clinician definition to include clinical social workers and certified nurse-midwives among those participating in MIPS,” the agency stated.
