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OnDemand Course

Medicare's Overhaul of Physician Payments

Gain an understanding of the updated payment changes reflective in the new year within Medicare restructured specifically for physicians.

Medicare is expected to impose far-reaching changes in how physicians are paid starting in 2019. The Centers for Medicare & Medicaid Services (CMS) has proposed the first major re-do in almost 20 years in how evaluation and management (E&M) services will be paid - these are an important part of billings for almost all specialties. CMS has proposed to simplify the E&M payment structure in ways that will, if adopted as proposed, create winners and loser and be disruptive for many specialties. This rule also contains various changes in the Quality Payment Program (QPP) that will affect physicians that do not participate in Advanced Alternative Payment Mechanisms, which include certain Accountable Care Organizations. CMS has also proposed various changes to Medicare's ACO program; the proposals have been criticized as 'raising the bar' for ACOs, making this alternative more difficult for physicians to use to share in savings or avoid payment cuts. Physician practices will thus have to weigh a revised set of options as they seek to avoid payment reductions and secure higher payments for their services. This topic will explore the changes CMS actually adopts for implementation in 2019 and equip participants to understand and react appropriately to these changes.

Runtime: 88 minutes
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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Changes in Payment for Evaluation and Management Services

  • Changes in Documentation Requirements
  • Proposals to Simplify the E&M Levels of Payment
  • Add-on Provisions for Particular Physician Services

Other Changes Affecting Physician Payment

  • Global Surgery Periods
  • Payment Rates for Practice Expense Inputs

Changes in the Quality Payment Program

  • Addition, Removal, and Revisions to Measures
  • Increased Weight Placed on Cost Performance Category
  • New Scoring Methodologies for Promoting Interoperability Category
  • What Do the Changes Do to Help Physicians Meet QPP Reporting Requirements and Avoid Payment Cuts?

Changes in Accountable Care Organizations

  • Which ACOs Are Affected and How
  • Toughening up of Requirements to Bear Risk
  • Improvements in Coverage of Services
  • Simplified Reporting Requirements
  • Are ACOs Still a Useful Strategy for Avoiding QPP Reporting Requirements and Possible Payment Reductions?

Summing up

  • Effects of the New Regulations on Physician Practices
  • What Can Physicians Do to Respond?
  • How Will These Changes Affect Companies That Supply Pharmaceuticals, Devices, and Other Inputs to Medical Care
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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Course

Applications have not yet been submitted for Delaware, Idaho, Kentucky, Ohio, Oklahoma, South Carolina, and Wyoming CLE for this course. However, if you are interested in obtaining CLE for any of the listed states or have any additional credit questions please email us at [email protected] or call us at 866-352-9540.

This course was last revised on December 3, 2018.

Call 1-866-352-9540 for further credit information.

  • CA MCLE 1.5
     
  • Lorman Business Center, LLC. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.5 CLE hours of participatory credit.
     
  • WA CLE 1.5
     
  • This program has been approved by the Washington State Board of Continuing Legal Education for 1.5 hours of A/V credit under the Law & Legal Procedure category.
     

To earn each credit Lorman offers through the OnDemand learning platform, you need to watch 100% of the program. Also, for certain credits you will need to fulfill additional requirements which will be displayed on the "credits" tab when viewing the course.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Thomas Gustafson, PhD

Thomas Gustafson, PhD

Arnold & Porter LLP

  • Policy Advisor in Arnold & Porter’s Life Sciences and Healthcare Regulatory Practice, where he concentrates on Medicare reimbursement and related issues and on health policy generally
  • Distinguished 30-year career at the United States Department of Health and Human Services (HHS) in 1976 included more than 20 years at CMS, where he held several executive posts responsible for Medicare and Medicaid legislation, strategic planning, research and demonstrations, operations, and development and implementation of regulations
  • In 2003, Dr. Gustafson was named Deputy Director of the Center for Medicare Management (CMM), which coordinated the fee-for-service portion of the Medicare program and set payment rates for more than a million providers
  • Advised health-care providers, device and pharmaceutical manufacturers, and trade associations on a wide array of issue areas, including: physician, hospital and end-stage renal disease reimbursement systems; accountable care organizations; laboratory coverage, coding and payment; and launch and reimbursement issues for devices and pharmaceuticals
  • J.D. degree, Williams College; PhD, Yale University
No photo available

John McInnes, MD, JD

Arnold & Porter Kaye Scholer LLP

  • Counsel in Arnold & Porter’s Life Science and Healthcare Regulatory Practice, where he specializes in reimbursement issues affecting physicians and other practitioners and device and pharmaceutical manufacturers
  • Practiced as a board-certified ophthalmologist for several years before becoming a lawyer
  • Served for several years at CMS directing the divisions responsible for the development of national Medicare payment policies for hospital outpatient departments, ambulatory surgery centers, and physician services, among others
  • Led a team charged with developing, implementing and evaluating new payment models now included in the QPP
  • J.D. degree, University of Texas; MD degree, Duke University
Paul Rudolf, MD, JD

Paul Rudolf, MD, JD

Arnold & Porter Kaye Scholer LLP

  • Partner in Arnold & Porter’s Life Sciences and Healthcare Regulatory Practice
  • Experienced in both Medicare and FDA legal, regulatory and policy issues and is widely recognized for advising clients with coverage, coding, and reimbursement issues relating to Medicare’s physician and hospital payment systems
  • Practiced medicine for more than 15 years and taught at George Washington University before becoming a Medicare Carrier Medical director
  • Joined CMS, where he led policy development for the physician fee schedule and the hospital outpatient prospective payment system
  • J.D. degree, The George Washington University’ MD the University of Florida
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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

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Product ID: 404541
Published 2018
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