Changes in 2020 Medicare Physician Fee Schedule and OPPS

Goals

To understand the changes to the 2020 Medicare Physician Fee Schedule and the Outpatient Prospective Payment (OPPS).

Early Findings

  • Physicians will see a virtually flat conversion factor, moving from $36.04 to $36.09.
  • There is an outpatient rule 2.6% payment update for hospitals.
  • The highest increases in total allowed charges are clinical psychologist (3%), clinical social worker (3%) and neurology (2%). The biggest decreases are ophthalmology (-4%), diagnostic testing facility (-2%) and optometry (-2%).
  • The schedule will also include the long-awaited "implementation of the long-awaited mandate requiring that clinicians consult appropriate use criteria through a qualified clinical decision support mechanism when ordering advanced imaging services."
  • CMS is now transitioning to reimbursement for principal care management instead of chronic care management.
  • The new OPPS strives to increase choice and encourage site neutrality.
  • "Total Knee Arthroplasty (TKA), Knee Mosaicplasty, six additional coronary intervention procedures, and twelve procedures with new CPT codes to the ASC CPL." have been added to the covered procedures list for ASCs.

Proposed next steps:

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We propose detailed research describing how the 2020 Medicare Physician Fee Schedule and the Outpatient Prospective Payment System is a change from the previous year, especially regarding payment structures and reimbursement rates. We then will also synthesize how the changes within both policies is emphasizing value-based care.
Alternatively, we could take a broader view and use expert opinions and analysis to highlight select changes in the 2020 Medicare Physician Fee Schedule and the Outpatient Prospective Payment System to explain how the CMS is moving towards value-based care.