SNF care coordination, 3-day stay rule targeted in 2017 doc fee schedule

“If this rule is finalized, it will put our nation's money where its mouth is," said CMS Acting Administrator Andy Slavitt.
“If this rule is finalized, it will put our nation's money where its mouth is," said CMS Acting Administrator Andy Slavitt.

The Centers for Medicare & Medicaid Services has released its proposed physician fee schedule for calendar 2017, and it includes significant aspects for care transition management and the skilled nursing 3-day stay waiver.

Healthcare providers are not currently required to use a specific tool to exchange patients' medical records, as long as they are sent electronically. Under the CMS proposal issued Thursday, the agency would no longer standardize the content of the records or how providers must exchange patient documents — as long as it is done in a timely manner.

Those changes would help improve care transitions and communication between skilled nursing facilities, hospitals, clinicians and other settings, according to CMS.

“This proposal is not intended to undermine the significance of a standardized, electronic format and means of exchange of all relevant patient health information,” CMS said in the proposed rule. “However … we have not applied similar requirements to other [physician fee schedule] services specifically and have concerns about how doing so may create disparities between these services and others under the PFS.”

CMS also proposed protections for Medicare beneficiaries who receive care under an accountable care organization that waives the 3-day stay rule for skilled nursing care.

Specifically, the provisions would add extra time for CMS to tell ACOs about any beneficiaries' financial liability for non-covered skilled nursing services that may be linked to use of the 3-day stay waiver. That added “grace period” would allow ACOs to communicate any beneficiary exclusions to skilled nursing facilities, CMS said.

The fee schedule also includes a provision that would limit 3-day stay waiver use to ACOs in Track 3. Other revisions relating to ACOs and the Medicare Shared Savings Program include changes to take beneficiaries' preferences into account for ACO assignment.

The proposed fee schedule also would require healthcare providers and suppliers to be screened and enrolled in Medicare before being able to contract with Medicare Advantage health plans.

Other proposed provisions in the schedule include expanding a program aimed at diabetes prevention, and expanding telehealth services to include advance care planning services. The proposals would “give a significant lift” to how physicians tend to patients and coordinate their care, said CMS Acting Administrator Andy Slavitt.

“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,” Slavitt said.

The calendar 2017 physician fee schedule is open for public comment until Sept. 6.