In late December, CMS and its contractor, Acumen LLC, convened a technical expert panel (TEP) to gather input on its Physician Cost Measures and Patient Relationship Codes (PCMP) project. Jay K. Nathan, MD, FAANS, was appointed to serve on this TEP on behalf of the AANS and the CNS. The TEP provided guidance to CMS on the prioritization of episode-based cost measure development under the Merit-Based Incentive Payment System (MIPS). Dr. Nathan called for a more patient-centered approach to cost measure development, suggesting CMS focus on which diagnoses are driving the most cost to the program rather than on developing additional cost measures simply to fill remaining specialty gaps.
CMS also announced plans to soon begin work on new “value” measures in response to concerns raised by Dr. Nathan and others that existing cost measures fail to concurrently account for quality. The TEP also discussed the use of patient-relationship codes (PRCs) to facilitate attribution of episodes to clinicians for purposes of cost measurement. Section 1848(r) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to create PRCs, with clinical expert input, to facilitate the attribution of patients to clinicians for purposes of cost measurement under MIPS. Current cost measures are attributed based on specific billing patterns, using service and diagnosis codes, but CMS believes that PRCs could facilitate attribution of episodes to clinicians who serve patients in different roles (e.g., provide additional information about attributable clinicians when multiple clinicians are involved in an episode, or when clinicians are providing care only as ordered by another clinician).
To date, PRCs have only been tested on a voluntary basis, which has resulted in low adoption rates. CMS plans to continue to conduct future analyses to explore the use of PRC for cost measurement. Click here to read more about CMS’ work on PRCs to date.
