2019 HSC Section 2 - Practice Management

J A M A CAD D ERMATOL A PRIL 2018

Barbieri et al

valued in this system. This concept is also referred to as budget neutrality, which simply indicates that the RUC has no control over the budget allocated to pay for the services it evaluates, only to adjust the relative valuation between services.

practice of dermatologists. This committee ensures that clinicians receive appropriate reimbursement for their services and that new reimbursement codes are developed as technology and research lead to novel services and procedures. REFERENCES 1. Hsiao WC, Braun P, Yntema D, Becker ER. Estimating physicians’ work for a resource-based relative-value scale. N Engl J Med . 1988;319(13):835-841 . 2. Hsiao WC, Stason WB. Toward developing a relative value scale for medical and surgical services. Health Care Financ Rev . 1979;1(2):23-38 . 3. Panetta L. H.R.3299 e 101st Congress (1989-1990): Omnibus Budget Reconciliation Act of 1989. Published December 19, 1989. Available from: https://www.congress.gov/bill/101st- congress/house-bill/3299 . Accessed May 8, 2017. 4. AmericanMedical Association. RVS update process. Available from: https://www.ama-assn.org/sites/default/files/media-browser/ public/rbrvs/ruc-update-booklet_0.pdf . Accessed May 8, 2017. 5. American Medical Association. RVS Update Committee (RUC). Available from: https://www.ama-assn.org/rvs-update- committee-ruc . Accessed May 8, 2017. 6. American Medical Assocation. History of Medicare conver- sion factors. Available from: https://www.ama-assn.org/ sites/default/files/media-browser/public/physicians/ practice-management/cf-history.pdf . Accessed July 23, 2017. 7. Members of the RVS Update Committee (RUC) j AMA. Available from: https://www.ama-assn.org/about-us/composition-rvs- update-committee-ruc . Accessed May 8, 2017. 8. AmericanMedical Association. RUC recommendations, minutes & voting. Available from: https://www.ama-assn.org/ruc- recommendations-minutes-voting . Accessed July 25, 2017. 9. Centers for Medicare and Medicaid Services. Proposed policy, payment, and quality provisions changes to the Medicare physician fee schedule for calendar year (CY) 2017. Available from: https://www.cms.gov/Newsroom/MediaReleaseDatabase/ Fact-sheets/2016-Fact-sheets-items/2016-07-07-2.html . Accessed May 11, 2017. 10. Centers for Medicare and Medicaid Services. Global surgery data collection. Available from: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Global- Surgery-Data-Collection-.html . Accessed June 7, 2017. 11. Burgess M. H.R.2 e 114th Congress (2015-2016): Medicare Access and CHIP Reauthorization Act of 2015. Available from: https:// www.congress.gov/bill/114th-congress/house-bill/2 . Accessed January 9, 2016. 12. Barbieri JS, Miller JJ, Nguyen HP, et al. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children’s Health Insurance Program Reauthorization Act and the Merit-based Incentive Payment System. J Am Acad Dermatol . 2017;76(6):1206-1212 . 13. Barbieri JS, Miller JJ, Nguyen HP, et al. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children’s Health Insurance Program Reauthorization Act and alternative payment models in dermatology. J Am Acad Dermatol . 2017; 76(6):1213-1217 . 14. Barbieri JS, Miller JJ, Nguyen HP, et al. Commentary: future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and CHIP Reauthorization Act of 2015. J Am Acad Dermatol . 2017; 76(6):1203-1205 .

PROMINENT ISSUES FOR DERMATOLOGISTS Global periods

Global periods are a mechanism by which subsequent care (eg, postoperative visits such as suture removal and wound checks) that is provided during a predefined follow-up period is bundled together with the payment for the initial visit. Global periods were initially created to incentivize physicians to use follow- up care visits efficiently, while also protecting the Medicare budget from inappropriate overutilization of follow-up care. However, over time there has been growing concern that codes associated with global periods are generally overvalued because the patient often receives less follow-up care than what is covered by the code, which has led to interest in replacing the 10- and 90-day global periods with zero-day global periods. As a result, CMS is interested in collecting rudimentary data on postoperative visits and is requiring clinicians in select states that meet certain narrow parameters to report these visits using CPT code 99204 starting July 1, 2017. 9,10 Alternative payment models With the introduction of the Medicare Access and Children’s Health Insurance Program Reauthorization Act, most clinicians will now have to choose whether to participate in the Merit-based Incentive Payment System or alternative payment models (APMs), which are covered in detail in earlier articles in this series. 11- 14 As dermatology-specific APMs are developed, it is likely that the RUC will have a significant role in determining how to value these novel APMs. While the ultimate review process is still being developed, the RUC-CPT joint Emerging Issues Workgroup has begun to investigate this issue, and it is likely that many of these APMs will be valued by combining various inputs from the related fee-for-service components that are included in the APM. Because APMs are required to bear financial risk, which is not typically included in the standard RVU calculations, it will also be important to consider whether and how to appropriately reimburse clinicians for managing this additional risk found in APM models of care. CONCLUSION The RUC represents an important avenue for all physicians to have access to the CMS reimbursement process, and its work is critical for the day-to-day

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