Medicare Proposes Improvements to Paying for Care Coordination, Primary Care, and Mental Health: Doctor Payment Rule

The Doctor Payment Rule has been proposed by the Centers for Medicare & Medicaid Services (CMS) to change the Physician Fee Schedule and improve the way Medicare pays for primary care. The changes focus on care management and behavioral health, and are designed to underscore the importance of services primary care providers and other providers offer to patients with multiple chronic conditions, mental and behavioral health issues, as well as cognitive impairment or mobility-related impairments.

The rule consists of payment for:

  • new codes and extra care management following the initial visit of a patient with multiple chronic conditions; and

  • behavioral health care using the Collaborative Care Model (a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant) and other approaches to behavioral health integration.

  • Services will include, but will not be limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services provided in calendar year 2017. Proposed changes will expand the Diabetes Prevention Program starting in January 2018. This expansion will be the first time a preventive service model from the CMS Innovation Center is implemented into the Medicare program.

    “[The] proposals are intended to give a significant lift to the practice of primary care and to boost the time a physician can spend with their patients listening, advising and coordinating their care—both for physical and mental health. If this rule is finalized, it will put our nation's money where its mouth is by continuing to recognize the importance of prevention, wellness, and mental health and chronic disease management.”

    Overall, the rule will support clinicians who are investing time and resources to provide more coordinated and patient-centered care; better represent the resources involved in maintaining current primary care, care coordination and planning, mental health care, and care for cognitive impairment; and uphold the CMS’ efforts to “align priorities and reward physicians for quality care.”

    See the related press release:

    https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-07-07.html

    Visit the CMS Blog to learn more about efforts to improve primary care:

    https://blog.cms.gov/2016/07/07/focusing-on-primary-care-for-better-health/