CMS Submits Proposed Rule Changes for Fee-Based Services

Published August 17, 2018

“CMS is moving toward site neutral payments for clinic visits (which are essentially check-ups with a clinician),” CMS stated in a press release.

“Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting,” the release stated.

The proposed rule is part of a package of reforms for “achieving greater price transparency, interoperability, and significant burden reduction so that hospitals and ambulatory surgical centers can operate with better flexibility and patients have what they need to become active healthcare consumers,” CMS stated. The deadline for comments on the proposed changes is September 24.

‘It’s an Ideal Arrangement’

John Dunn, a physician, lawyer, and policy advisor for The Heartland Institute, which publishes Health Care News, says fee-based care provides what many people want from medical providers and offers a better care model for older people.

“When you’re young, you don’t go to the doctor unless you have an acute illness or get injured or something like that,” Dunn said. “But as you grow older, you get medical conditions that require continuous, systematic care, so I would say that for Medicare it’s an ideal arrangement between a patient and a physician because the patients in the Medicare population frequently have chronic diseases that require regular doctor visits.”

Recommends Extending to Medicaid

Dunn says the proposed reform should be extended to Medicaid because of the high rate of close physician attention its patients require.

“It’s true of Medicaid too, because the Medicaid population requires a certain amount of continuing attention and a lot of Medicaid patients are on disability,” Dunn said. “They are bigger consumers of health care services than what you might call ‘regular people’ who are in the insurance market looking for insurance.

“Instead of letting them take their best shot at trying to find a doctor who will take Medicare and Medicaid, what these patients do with their relationship with a physician is going to be determined by the physician and patient relationship, not by Medicare and Medicaid, other than by the fact that Medicare and Medicaid are helping to pay for it.”

‘Cash and Carry’

Dr. Roger Stark, a health care policy analyst at the Washington Policy Center and a retired physician, says fee-based medical practices reduce the market distortions third-party payment creates.

“Direct primary care is just like the old days—it’s like cash and carry,” Stark said. “There’s no insurance between the patient and the doctor.

“Giving a Medicare patient a voucher and letting that patient go into the private market with that voucher and purchasing their own health insurance and then going to see whatever doctor they want to go see is one of the answers to instilling the free market in the whole program and reforming it,” Stark said.



“CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule,” Centers for Medicare and Medicaid Services, July 25, 2018: