NPCHPC – CMS work together to exempt small / rural practices

Marcy ZwellingUncategorizedLeave a Comment

i’m thrilled to report that the national physicians’ council for healthcare policy has made great progress working with CMS on exemption.

The following is a slide that is “our ask” – please see slides # 6

Exempting small and rural practices

•200 or fewer unique Medicare patients OR
•Less than $500,000 in MC payments per physicians* OR
•*When considering costs and exemptions if it costs $50,000 per physician to setup system you need to receive the 5% bonus on $1,000,000 collection from Medicare. If maintenance is $20,000 then you have to collect $400,000 just to break even.
•Practices with 10 or fewer physicians OR
•Rural physicians** OR
•** physician/population ratio < 100. As an aside, we believe that this might help with the current maldistribution of physicians in favor of metro areas.
•Physicians or facilities who have no EHR

numbers one and two are purely regulatory and CMS is planning on helping us with these come spring – numbers 3-5 require statutory changes and we’re working with Congressmen Sessions and Walden ( new chair of E&C) for help.

Key to our relationship with CMS is our suggestion that those docs or groups who have made the investment in MACRA/MIPS should be able to move along and get a bonus- we don’t try to micromanage the legislation or the regulation  –but this is a zero sum game – we were challenged by CMS to find money for the bonus – and we were able to come up with an answer – MIPS CHOICE

see the slide marked **

MIPS CHOICE is a voluntary program open to all specialties and applies ONLY to E&M coding. Doctors willing to take a 10 % cut may bill the patients for the balance of their posted price and the Medicare payment. (what we had previously called balance billing) – Doctors will be required to post their retail cash prices and patients may elect to participate or not. This allows a physician to sell new products – for instance Dr. Smith says to his patients that he would like to like to be able to spend a full hour with her and his price is $200 per hour. Medicare will pay $75 for a 99214 and the patient will owe $125.00. She tells her doctor she can only afford $100 and Dr. Smith says that’s fine. He may earn any amount up to $200 but not more.

This allows us to get private contracting into law – save medicare – and save MACRA/MIPS for those who like it ….. CMS will assist in exempting those in small and rural practices – patients keep their doctors and doctors have more autonomy –

comments are welcome
next council meeting is Sunday March 19th … please put it on your calendar and thanks to all who joined us last week …..91 docs paid their own way and participated in a hugely dynamic discussion !

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