Public Payers News

URAC Stresses Accreditation in Medicare Physician Fee Schedule

In a letter to CMS, the nonprofit URAC discussed the importance of accreditation within the Medicare Physician Fee Schedule proposed rule.

By Vera Gruessner

This past July, the Centers for Medicare & Medicaid Services (CMS) released revisions to the Medicare Physician Fee Schedule for next year and placed the proposed rule on the Federal Register for display. CMS called on for payers, providers, and other healthcare organizations to submit comments regarding the changes to the Medicare Physician Fee Schedule.

Telemedicine Quality Screening

The nonprofit organization URAC submitted comments to CMS in August regarding the quality screening and accreditation that could be used by CMS in revising payment policies under the Medicare Physician Fee Schedule. The letter sent to CMS Acting Administrator Andrew Slavitt details the importance of ensuring quality is as high in telehealth services as in-person patient care as well as the need to enforce accreditation in managed care, pharmacy benefit management, disease management, and wellness programs.

Aaron Turner-Phifer, Director of Government Relations and Policy at URAC, spoke with HealthPayerIntelligence.com to provide more information regarding the organization’s Medicare Physician Fee Schedule comments.

When asked about key quality accreditation guidelines that URAC supports for CMS oversight in the revised Medicare Physician Fee Schedule, Turner-Phifer responded, “We’ve got two dozen or more accreditation programs that run the gamut of all the way from a simple provider-led organization or a specialty pharmacy to all the way to an ACO or a health plan. One of the things that we tried to stress and highlight in our letter to CMS is that if you’re going to go the path of screening contracted providers and suppliers in Medicare Advantage, there are quality initiatives in the industry that have years of track record that CMS can rely on.”

“One of the things that we believe here at URAC is that, where possible, we should be able to ease the administrative burden on practitioners and managed care organizations alike with the idea that it will save costs for both the patients and taxpayers,” Turner-Phifer continued. “Any place that we can align efforts to meet that and maintain quality for the patient should be something that we work together toward. This seems to be an area where accreditation is important like telehealth accreditation, case management, disease management, pharmacy benefit accreditation that CMS could rely on.”

Turner-Phifer went on to explain that URAC understands CMS’ reasoning behind the new Medicare Physician Fee Schedule proposed rules. First, CMS is looking to “protect the integrity” of the Medicare program itself. Secondly, the rulings are looking to improve patient safety and keep patients out of harm’s way, said Aaron Turner-Phifer. Finally, he mentioned how URAC can help the agency quality screening of providers and suppliers.

As previously mentioned, the URAC letter noted the importance of accreditation within the telemedicine sphere. When asked about quality screening of telehealth and which guidelines CMS should incorporate, Turner-Phifer answered, “We actually launched, at the beginning of this year, telehealth accreditation. This is a pretty robust set of standards that we have. This could be used for either commercial entities that are providing telehealth services directly to a consumer or this could be health systems that are utilizing telehealth within their system to deliver care.”

“Our accreditation program looks at the operations that these organizations have in place to ensure that they have the appropriate credentials for their physicians, a secure way to communicate and deliver encrypted data, and some consumer safeguards around confidentiality in place to protect the integrity of the care they’re providing,” he added. “If CMS is going down the route of enrolling contractors of Medicare Advantage, one of the groups that might fall into this category are telehealth providers contracted with Medicare Advantage plans.”

According to an issue brief from URAC, the future of telehealth implementation will likely be driven by changes in reimbursement structures for these technology-based healthcare services. With a greater shift toward value-based care reimbursement, telehealth coverage from Medicare, Medicaid, and private insurance markets are more likely to expand.

When asked what steps CMS can take to work with suppliers to improve patient safety and health outcomes while cutting costs in the new value-based care environment, Turner-Phifer explained, “From our perspective as an accreditor, some of the things that CMS has already taken steps on for value-based care include engaging stakeholders in MACRA implementation and engaging providers in the core measure set collaborative that they announced in February.”

“CMS could take steps by trying to reduce some of the burden and focus quality efforts  around some core clinical measures. Those are positive steps in the right direction,” he continued. “I think Medicare Advantage’s role in MACRA implementation and the larger CMS efforts around value are critical. As much as an accreditor is looking at working with the very same group of people that CMS is working with, I think we have an opportunity as an industry to come together with CMS and accreditors and continue to focus those quality initiatives.”

“By leveraging an independent accreditor, you have the opportunity to reduce some of the administrative burden and allow CMS to focus on the critical issues that demand oversight while leveraging third party accreditors to do some of the other validation of operations,” he concluded.

 

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