Becker's Hospital Review

8 CFO / FINANCE CMS' final physician payment rule for 2019: 6 things to know By Ayla Ellison C MS issued its annual update to the Medicare Physician Fee Schedule Nov. 1, which overhauls Medicare billing and expands coverage of telehealth. Here are six takeaways from the final rule: 1. Physician payment rates. e 2019 physician fee schedule conversion factor is $36.04, which is up from $35.99 this year and reflects a budget-neutrality adjustment re- quired by law. 2. Evaluation and management cod- ing and payment changes. CMS final- ized several coding and payment changes aimed at reducing administrative burden and improving payment accuracy for evaluation and management visits. For example, the final rule allows practitioners to review and veri- fy certain information in a patient's medical record that is entered by ancillary staff or the patient, rather than re-entering the informa- tion. For 2021 and beyond, CMS will con- solidate the payment rate for E/M visit levels 2 through 4 while maintaining the payment rate from E/M visit level 5, which is the high- est-paying code. 3. Site-neutral payment policies. Un- der the final rule, CMS will continue site-neu- tral payment policies under Section 603 of the Bipartisan Budget Act. Off-campus facilities built aer Nov. 2, 2015, will be paid 40 per- cent of the Outpatient Prospective Payment System amount for 2019. 4. Telehealth services. CMS will pay phy- sicians for their time when they check in with Medicare beneficiaries via telephone or an- other telecommunications device. Physicians will also be paid for the time it takes to review a video or image sent by a patient to assess whether a visit is needed. 5. Merit-based Incentive Payment System. For 2019, CMS is adding eight MIPS quality measures, including four based on patients' reporting of their outcomes. CMS is removing 26 quality measures. Aer receiv- ing concerns from clinicians who were not eligible to participate in the MIPS program during the first two years, CMS is expanding the program to include physical therapists, occupational therapists, speech pathologists, audiologists, clinical psychologists, and reg- istered dietitians or nutrition professionals. CMS is also finalizing an opt-in policy that allows some clinicians who otherwise would have been excluded under the low-volume threshold the option to participate in MIPS. 6. American Hospital Association weighs in. "[e] rule will have positive and negative consequences for America's hospitals and health systems and the patients they serve," said Ashley ompson, AHA se- nior vice president of public policy analysis and development. Specifically, the AHA ap- plauded CMS for expanding physicians' abili- ty to serve patients through telehealth, but the group expressed disappointment with CMS' policies regarding site-neutral payments. n Shuttered Virginia hospital plans to reopen Dec. 27 By Alia Paavola F ive years after Kingsport, Tenn.-based Wellmont Health System shuttered Pennington Gap, Va.-based Lee Coun- ty Regional Medical Center, the hospital plans to reopen under a new operator, according to a WYMT news report. Wellmont closed the medical center in 2013, citing a lack of patients and declining reimbursements for patient care. It was the only hospital in Lee County. In 2017, a Florida-based startup, Americore Health, pur- chased the medical center for $2 million, with plans to re- open the hospital as a 25-bed inpatient facility. The Lee County hospital has been under construction since January and was initially slated to reopen in July. However, the project was delayed until December. Now, the hospital authority is holding Americore to a reopen- ing date of Dec. 27, according to Jeanette Filpi, CEO of the Lee County hospital. "We continue to push on this [deadline] daily. We don't in- tend to give up," Commissioner Howard Elliott of the Lee County Hospital Authority told WYMT. n Northwell Health launches $1B fundraising campaign By Leo Vartorella N ew Hyde Park, N.Y.-based Northwell Health launched a seven-year, $1 billion fundrais- ing campaign to support capital, research and innovation initiatives. "Outpacing the Impossible: the Northwell Campaign" has raised almost $500 million since Jan. 1, 2016, but during an event Oct. 17 with over 600 of Northwell's highest-level donors, the organization made the cam- paign public. The initiative will fund innovation and re- search in areas such as pediatrics, women's health, vet- eran programs and development of Northwell facilities in New York cities. "Philanthropy is critical to Northwell Health," said Brian Lally, Northwell's senior vice president and chief devel- opment officer. "Philanthropy is our investment back into our communities and helps us to take better care of more people." The campaign has four key pillars: drive to discover, disruptive thinking, pioneering solutions and seeing people fully. n

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