Washington Update - October 2013

The American Geriatrics Society (AGS) recently submitted comments and suggestions to the Centers for Medicare & Medicaid Services (CMS) regarding the agency’s proposed 2014 Medicare Physician Fee Schedule (www.americangeriatrics.org/files/documents/Adv_Resources/comment_letter0...).

For geriatricians, a key issue in CMS’ recommendations is its proposal to create two separately payable, complex chronic care management (CCCM) G-codes in calendar year 2015 for services furnished to beneficiaries who meet certain criteria. To meet these, beneficiaries must have two or more complex, chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death or acute exacerbation/decompensation, or functional decline. For more details, see story that follows.

The AGS’ letter cites several other recommendations in CMS’ proposed 2014 fee schedule that may significantly affect geriatricians. In response to this, AGS is suggesting that the agency add new current procedural terminology (CPT) codes for transitional care management services (99495 and 99496) to the list of Medicare telehealth services, along with the codes for Medicare’s annual wellness visit.

In its comments, AGS also objects to CMS’s proposal to increase the number of measures that physicians must report under the Physician Quality Reporting System—from three to nine—and recommends that the agency determine whether each specialty has sufficient relevant measures to justify this increase. Finally, the AGS asks CMS to provide additional guidance regarding its plans to implement the value-based payment modifier for smaller physician practices in calendar year 2017 and beyond.

The Centers for Medicare & Medicaid Services (CMS) recognizes, in its calendar year 2014 Medicare Physician Fee Schedule proposed rule, that its historical reimbursement for face-to-face E/M services does not adequately account for the typical non–face-to-face care management work required with certain categories of beneficiaries. Accordingly, CMS is proposing to establish a separate payment in the calendar year 2015 physician fee schedule for complex chronic care management (CCCM) services.

In response to this, the American Geriatrics Society (AGS) convened a multispecialty working group to assess the risks and benefits of CMS’ proposal, and ultimately submitted a number of comments (www.americangeriatrics.org/files/documents/Adv_Resources/CCCM_joint_comm...) intended to fine-tune the agency’s proposal. Most notably, the AGS recommends that CMS not adopt its proposed CCCM G-codes, and instead implement the two existing complex chronic care coordination current procedural terminology (CPT) codes recently adopted by the American Medical Association’s Specialty Society Relative Value Scale Update Committee. In addition, the AGS suggests that CMS provide greater clarification regarding the coding requirements for CCCM services and develop alternative pathways for a practice to demonstrate that it has the resources to provide reimbursable CCCM services.

In the letter, AGS further argues that any coding requirements designed to protect beneficiaries—such as informed consent and documentation protocols—must not serve to limit access to these important services, and that practices must be allowed to provide these services through independent contractors and affiliates other than traditional W-2 employees. Although the agency’s proposal represents an important step forward, the comments and concerns noted by the multispecialty working group highlight the improvements that must be made to ensure that those beneficiaries who are most in need of these services have consistent access to them, the society’s letter emphasizes.

Home care workers must be paid minimum wage and overtime starting in 2015 under a Department of Labor decision issued in September. For decades, home care workers have been exempted from minimum wage rules because payment policies categorized their work as “companionship.” However, labor organizations and other advocates for these direct-care workers argued that they were often doing considerably more, including providing assistance with activities of daily living. The Eldercare Workforce Alliance (www.eldercareworkforce.org), which AGS COO Nancy Lundebjerg co-convenes, has long called for adequate pay and training for these essential members of the geriatrics care team.