AAFP 2023 MPFS Summary Details Payment, Policy Updates

Academy Continues Push for Congressional Action, Payment Reform 

November 16, 2022, 3:48 p.m. News Staff — The 2023 Medicare physician fee schedule and Quality Payment Program final rule reflects AAFP advocacy and includes wins for family medicine practices, but it also includes an untenable reduction in the 2023 Medicare conversion factor.

CMS finalized its proposal to create Medicare-specific coding for payment of Other E/M prolonged services, as adopted in 2021 for payment of Office/Outpatient prolonged services. The AAFP’s summary lists and explains these codes.

Medicare Economic Index

As proposed, the rule will rebase and revise the Medicare Economic Index, which measures changes in the market price of the inputs used to furnish physician services but had been relying mostly on data from 2006. CMS proposed using the 2017 U.S. Census Bureau’s Services Annual Survey data; however, the final rule includes some technical revisions, based on public comments.

“Because the new MEI cost weights would likely result in significant changes to payments among PFS services, the rebased and revised MEI weights were not used in CY 2023 PFS rate setting to ensure payment stability,” the Academy’s summary says. The final rule’s 2023 MEI is 3.8%.

The AAFP, the AMA and more than 100 other medical societies continue to ask Congress to enact positive, MEI-baselined annual updates to Medicare physician pay, reflecting inflation in practice costs.

Determination of Practice Expense Relative Value Units

The rule finalizes a series of standard technical proposals involving practice expense, including the implementation of the second year of the clinical labor pricing update for which the Academy staunchly advocated.

Telehealth

The rule maintains services included on the Medicare Telehealth Services List through at least the end of 2023 (and, after that, 151 days following the end of the COVID-19 public health emergency if the PHE lasts beyond next year). “CMS will also continue paying for services included on the telehealth list as of March 15, 2022, that are furnished in an audio-only telecommunications system for 151 days after the end of the PHE,” the summary notes.

Following AAFP advocacy, CMS agreed to continue paying for Medicare telehealth services as though they were provided in-person, instead of reducing payments for telehealth to the facility rates, through the end of 2023. CMS had proposed to automatically revert to the lower facility payment rate once the PHE-related telehealth waivers expired. With the AAFP’s support, the rule also delays the in-person requirements for tele-mental health visits, including those furnished by rural health clinics and federally qualified health centers.

Valuation of Specific Codes

In a win for the Academy, the final rule sets immunization administration valuations (CPT codes 90460, 90461, 90471, 90472, 90473 and 90474) that reflect payment advocacy. While these codes aren’t used in Medicare, keeping their values up to date is important for family physicians’ payment from other insurers.

“Consistent with the AAFP’s recommendations, CMS finalized the RUC recommended work RVUs for all six immunization administration codes and did not finalize the clinical labor time proposal, and will restore the one minute of clinical labor time for the CA008 activity for CPT codes 90460 and 90471-90474,” the summary says.

The summary lists several other valuation revisions affecting family physicians, including

• code descriptor changes for annual alcohol misuse and annual depression screenings (HCPCS codes G0442 and G0444), as requested by the AAFP;
• separate coding and payment for chronic pain management, with CPM codes permanently added to the Medicare telehealth services list; and
• new coding for general behavioral health integration billed by clinical psychologists and clinical social workers.

Part B Payment for Vaccine Administration

“Consistent with the AAFP’s advocacy, CMS finalized its proposals to update the Medicare Part B payment for administration of the influenza, pneumococcal, hepatitis B and COVID-19 vaccines, based on the annual increases to MEI, and to geographically adjust the payments,” the summary says. These updates will help ensure payment rates keep pace with rising costs.

Medicare Shared Savings Program

The Academy’s summary notes that a number of the final rule’s changes to the Shared Savings Program “are directionally consistent with the AAFP’s advocacy to improve value-based care participation opportunities for FPs, particularly those caring for rural and other underserved populations.”

Beginning in 2024, for instance, CMS will make advanced shared savings payments available to low-revenue accountable care organizations that are inexperienced with performance-based risk Medicare ACO initiatives and new to the MSSP. “Advance investment payments would increase when more dual-eligible beneficiaries or beneficiaries who live in areas with high deprivation are assigned to the ACO,” the summary adds before outlining the new AIP procedure.

The rule also gives ACOs more time before they are required to move into more advanced participation levels. ACOs inexperienced with performance-based risk will be able to enter and remain in BASIC track Level A for all five years of the agreement period, starting in 2024. ACOs participating in Level A or B in 2023 or 2024 will be able to continue in their current level of the BASIC track for the remainder of their agreement.

The rule restores a modified sliding scale to determine shared savings. “Beginning in 2023, ACOs that fail to meet the existing criteria under the quality performance standard to qualify for maximum sharing rate may be eligible to share in savings at a lower rate if the ACO achieves a quality score in the 10th percentile or higher for at least one of the four outcome measures in the APM Performance Pathway measure set,” the summary says. “The ACO’s sharing rate would be scaled to reflect the ACO’s quality score.”

The final rule’s changes to the financial methodology include

• incorporation of a prospective administrative growth factor into a three-way blend with national and regional growth rates to update an ACO’s historical benchmark,
• reinstituting an adjustment for prior savings when establishing benchmarks for renewing and re-entering ACOs and
• reducing the cap on negative regional adjustments.

Quality Payment Program

Beginning in 2023, CMS implements MIPS Value Pathways, which the agency says is a streamlined reporting option, for its Merit-based Incentive Payment System. The rule finalized five new MVPs and modifications to the seven previously established MVPs; among the new MVPs is one called Promoting Wellness, meant to target preventive care.

The summary details several other MIPS updates affecting some participating primary care practices, including MIPS Quality, MIPS Improvement Activities and MIPS Promoting Interoperability.

Advanced Alternate Payment Models

The final rule permanently establishes “the generally applicable revenue-based nominal amount standard at 8% of the average estimated total Medicare Parts A and B revenue of all providers and suppliers participating in APM entities for the Qualifying Participant performance period,” the summary says.

CMS also finalized an amendment to the 50-clinician limit for APMs participating in Medical Home Models. “CMS will apply the limit directly to the APM entity rather than the parent organization of the APM entity,” the summary notes. “However, the APM entity must remain below the 50-clinician limit for all three determination dates during the QP performance period.”