联邦医保中心定版2027年医师费表：重心转向预防与初级保健，同日重复计费削减两成
联邦医疗保险与医疗补助服务中心（CMS）11月4日宣布定版2027年度医师费表（PFS）最终规则，把医保B部分的支付政策重心从按量计费的「病后护理」转向预防与初级保健，并打击重复计费、堵住支付漏洞。
质量报告方面，规则标志着质量支付计划（QPP）实施十年：自2031执行年度起，CMS将正式停用传统的「基于绩效的激励支付系统」（MIPS）报告方式，临床医生可在2030年度前过渡到已覆盖约98%临床医生的 MIPS 价值路径（MVP）或高级替代支付模式——比拟议规则多给两年过渡期。规则另定版三条新的 MVP，分别聚焦糖尿病、高血压与住院医师，并要求临床医生自2027年度起至少报告一项专科「核心指标」。规则还定版两个专用于安宁计划（Advance Care Planning）的新计费代码，并把《工薪家庭减税法案》确立的非公民医保资格标准写入规则。
责任医疗组织（ACO）方面，规则给出的数据显示：2024执行年度，476家参与 ACO 中75%赢得共享结余、合计41亿美元，同时为医保信托基金相对预计支出净省约25亿美元；共享结余计划已连续八个执行年度为信托基金省钱。新规允许经批准的 ACO 自2027年4月1日起，为其归属受益人减免多项B部分服务与物品的费用分担，直接降低基本护理的自付成本；同时提高合格 ACO 的共享结余比例、为首次参与者提供新激励、让支出目标更可预测，并简化电子健康记录报告与患者通知要求。
支付诚信方面，规则重新校准费表估值以反映现代护理的真实复杂度，并堵住可被钻营的漏洞：当门诊就诊与一项小手术同日发生时，CMS将把其中成本较低一项的支付削减20%，减少患者与医保为已包含在手术估值中的临床工作重复付费。
卫生与公众服务部长 Robert F. Kennedy, Jr. 表示：「医保应当奖励让人们保持健康的临床医生。在特朗普总统的领导下，我们把预防与初级保健放在医保的中心，堵住支付漏洞，打击浪费。」CMS局长 Dr. Mehmet Oz 表示：「按服务付费太久以来奖励的是数量而非价值，助长了被动的病后护理体系。这项最终规则打破了这一现状。」
（来源：联邦医疗保险与医疗补助服务中心）
CMS Finalizes CY 2027 Physician Fee Schedule to Shift From Sick Care to Healthcare and Curb Waste
The Centers for Medicare & Medicaid Services (CMS) announced on November 4 that it has finalized the Calendar Year (CY) 2027 Physician Fee Schedule (PFS) final rule, modernizing payment policies under Medicare Part B to reward health maintenance and coordinated primary care rather than disjointed, volume-based intervention, while cracking down on duplicate billing and reinforcing fiscal stewardship.
Marking a decade of progress under the Quality Payment Program, CMS will officially sunset the traditional Merit-based Incentive Payment System (MIPS) reporting option beginning with the CY 2031 performance period. Clinicians will have through CY 2030 to transition to the MIPS Value Pathways (MVPs), which already cover approximately 98% of clinicians, or Advanced Alternative Payment Models, reflecting two additional years of transition time compared to the proposed rule. The rule also finalizes three new MVPs focused on diabetes, hypertension, and hospitalists, requires clinicians to report at least one specialty-specific "Core Measure" starting in CY 2027, finalizes two new billing codes dedicated to Advance Care Planning, and codifies noncitizen Medicare eligibility criteria established by the Working Families Tax Cuts legislation.
For Accountable Care Organizations (ACOs), CMS said that in performance year 2024, 75% of the 476 participating ACOs earned shared savings totaling $4.1 billion, while generating net savings for the Medicare Trust Funds of approximately $2.5 billion compared to projected spending benchmarks; the Shared Savings Program has generated savings for eight consecutive performance years. Under the final rule, starting April 1, 2027, approved ACOs may reduce or eliminate Part B cost-sharing for many items and services for assigned beneficiaries. The rule also increases shared savings rates for eligible ACOs, provides new incentives for first-time participants, sets more predictable spending targets, and simplifies electronic health record reporting and patient notice requirements.
On payment integrity, CMS is recalibrating fee schedule valuations and closing loopholes. When an office visit and a minor procedure occur on the same day, CMS will reduce payment by 20% for the lower-cost service, reducing duplication in payment for clinical work already covered in the procedure's valuation.
"Medicare should reward clinicians for keeping people healthy," said HHS Secretary Robert F. Kennedy, Jr. "Under President Trump's leadership, we are putting prevention and primary care at the center of Medicare, closing payment loopholes, and cracking down on waste." "For too long, fee-for-service payment has rewarded volume over value, fueling a reactive system of sick care," said CMS Administrator Dr. Mehmet Oz. "This final rule breaks from that status quo."
(Source: Centers for Medicare & Medicaid Services)
来源：联邦医疗保险与医疗补助服务中心
发布：GSM·美国（发布链接）
图片来源：图：医生在诊室为患者看诊并记录。Shixart1985 摄，CC BY 2.0，经 Wikimedia Commons。 / Photo: A doctor consulting a patient in her office. By Shixart1985, CC BY 2.0, via Wikimedia Commons.
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