- AMA-supported budget neutrality reform bill unanimously passes Ways and Means
- Survey: Health systems benefit from removing stigmatizing questions from credentialing applications
- Tell Congress: Support the Medicare Physician DPPS Act
- Update Medicare enrollment data for electronic prescribing of controlled substances
- AMA/Specialty Society RVS Update Committee submits recommendations to CMS
- More articles in this issue
AMA-supported budget neutrality reform bill unanimously passes Ways and Means
The effort to reform arcane and antiquated statutorily mandated requirements for the Medicare Physician Fee Schedule (MPFS) took an important step forward following the unanimous passage of H.R. 8163, the Provider Reimbursement Stability Act, out of the Ways and Means Committee on May 21. The final vote on the legislation was 44-0.
Introduced by Representatives Greg Murphy, MD (R-NC), Tom Suozzi (D-NY), John Joyce, MD (R-PA), Brad Schneider (D-IL), Mariannette Miller-Meeks, MD (R-IA), Jimmy Panetta (D-CA), Robin Kelly (D-IL), Kim Schrier, MD (D-WA) and Bob Onder, MD (R-MO), H.R. 8163, as passed, does the following (PDF):
Raises the existing $20 million budget neutrality trigger to $57.64 million.
Starting in 2033, the bill also requires this figure to be increased by the cumulative Medicare Economic Index (MEI) no less frequently than every 5 years.
Starting in 2029, requires the Secretary of HHS to prospectively revise spending estimates and budget neutrality adjustments based on actual after-the-fact utilization rates derived from claims data.
This provision only affects budget neutrality adjustments for newly unbundled codes where CMS has to estimate utilization—not changes to rates where CMS has historical utilization data for either an existing code or a set of codes, or where utilization crosswalks from existing codes are used for new codes.
This provision is only triggered when the newly unbundled code in question exceeds 0.1% of the total estimated expenditures.
Requires CMS to update the direct cost inputs for practice expense RVUs, specifically clinical wage rates, prices of medical supplies, and prices of equipment, simultaneously and not less often than every 5 years.
Starting in 2028, requires the Secretary of HHS to limit positive or negative increases to the MPFS conversion factor to no greater than 2.5% each year.
Prior to the markup, the AMA, along with 71 other national medical specialty societies and all 51 state medical associations (including Washington, D.C.), sent a letter (PDF) to Ways and Means Committee Chairman Jason Smith (R-MO) and Ranking Member Richie Neal (D-MA) in support of H.R. 8163. AMA will continue to work with bipartisan leadership in hopes of expeditiously passing this bill through the full House of Representatives before the conclusion of the 119th Congress.
Survey finds health systems benefit from removing stigmatizing questions from credentialing applications
Questions requiring disclosure of treatment and/or diagnosis of mental health or substance use conditions—when there is no current impairment—cause fear and stigma among clinicians, which leads them to avoid seeking care. A new survey (PDF) released by the AMA and Dr. Lorna Breen Heroes’ Foundation (LBF) found that health systems who have adopted the AMA and LBF recommendations experienced positive impacts across multiple areas, including improvements on:
- Use of mental health support services provided by the health system
- Improved patient safety/patient health outcomes
- The health system’s ability to recruit and retain physicians and advanced practice providers
- Increased disclosure of current impairment
- The ability to manage risk and liability
The survey, which included responses from 50 leading health systems, found no negative impacts across these areas.
“This survey provides powerful evidence that removing stigmatizing language from credentialing applications benefits physicians, residents, and medical students,” said AMA President Bobby Mukkamala, MD. “These real-world results are extremely promising and show more physicians are using mental health support services, with positive impacts across retention and clinician wellbeing. When physicians feel safe seeking care, patients benefit and our health system is stronger.”
“For the past five years, the AMA and Lorna Breen Foundation’s partnership has helped get us to the point where more than 2,100 hospitals have adopted our national best practice recommendations for credentialing applications,” said Corey Feist, CEO and President of the LBF. “The human case for removing fear and stigma is clear—this survey helps demonstrate the clear business case as well.”
Learn more about the AMA’s national campaign (PDF) and the positive results from the LBF.
Tell Congress: Support the Medicare Physician DPPS Act
For the past decade, the Merit-based Incentive Payment System (MIPS) has forced physicians to play a game of quality evaluation—one where physicians lose and patients pay the price. Now, Representatives Mariannette Miller-Meeks, MD (R-IA), and Herb Conaway Jr., MD (D-NJ), have introduced the Medicare Physician Data-Driven Performance Payment System (DPPS) Act of 2026 (H.R. 8622), a practical solution that will stabilize the MIPS program to ensure physicians can provide and patients can receive high quality care in their local communities.
Urge your representative to co-sponsor H.R. 8622 and ensure physicians can deliver quality care in their local communities.
Under MIPS, the Centers for Medicare & Medicaid Services (CMS) evaluates an individual physician’s performance by measuring quality, cost, health IT, and improvement activities to generate a total score on a scale of 0-100 points. Based on the score’s comparison to the MIPS national benchmark, physicians receive a penalty, neutral payment adjustment, or a bonus. The penalties and bonuses range from +/- 9% with the historical data demonstrating that low performing practices fund the bonuses for high performers.
As a result, the combination of excessive quality measurement programs and the win-lose “tournament model” inherent to MIPS has created three major issues:
- Significant administrative burden
- Steep penalties that disproportionately hurt small, rural and independent practices
- A lack of timely and actionable data
MIPS costs $12,800 and 202 hours per physician per year in paperwork and compliance, according to a 2022 JAMA study. CMS data from the 2023 Quality Payment Program (QPP) Experience Report shows that 29% of small practices, nearly 50% of solo practitioners, and 18% of rural practices received a MIPS penalty—jeopardizing patient access to local care, especially in underserved communities.
H.R. 8622 would solve these problems by:
- Freezing the performance threshold at 75 points for at least three years.
- Eliminating the MIPS win-lose “tournament style” payment adjustments (i.e., the +/- 9%) to ensure physicians are no longer subjected to steep penalties.
- In lieu of penalties, linking physicians’ MIPS performance to a portion of their annual payment update (e.g., either the existing 0.25% under MACRA or the percentage increase in the Medicare Economic Index, should it be enacted in a separate bill).
- Mandating that CMS fulfills its statutory obligations under MACRA to share data on a quarterly basis with the MIPS performance year, so physicians can leverage this data to implement changes that would improve patient care and use resources more efficiently. Failure by CMS to provide MIPS physicians with three quarters worth of data during the performance year results in physicians receiving the highest possible payment update.
Update Medicare enrollment data for electronic prescribing of controlled substances
This summer, CMS will be assessing physicians’ 2025 compliance with the Medicare electronic prescribing of controlled substances (EPCS) program requirements. The agency is asking physicians—by July 1—to make sure their contact information is accurate in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and the National Plan and Provider Enumeration System (NPPES). CMS will use the PECOS and NPPES addresses both to check which physicians qualify for an automatic declared disaster exception to the EPCS Program and to send non-compliance notices for the 2025 measurement year.
In response to AMA advocacy, Medicare’s EPCS program provides significant flexibility for physicians. In addition to those in a declared disaster area, physicians who issue fewer than 100 prescriptions for controlled substances to Medicare patients with Part D are exempt from the requirements and other physicians can ask that the requirement be waived for various reasons such as lack of reliable broadband access. Also consistent with AMA recommendations, compliance requires that 70% of physicians’ Part D controlled substance prescriptions be e-prescribed, not 100%, and CMS enforcement actions for noncompliance with EPCS rules is limited to sending a letter to the physician notifying them of their noncompliance.
The AMA encourages physicians to verify that their contact information is accurate and up-to-date in these Medicare databases. Additional information about the EPCS Program is available at the CMS EPCS Program webpage.
AMA/Specialty Society RVS Update Committee submits recommendations to CMS
The AMA/Specialty Society RVS Update Committee (RUC) submitted recommendations to CMS on May 11 related to services reviewed at the RUC’s April 23-25 meeting. These recommendations are publicly available. The RUC recommendations to CMS relate to the physician work and direct practice costs for several physician services, including: destruction of benign lesions; adjacent tissue transfer; goniotomy; closed treatment of distal radial fracture; and endoscopic decompression of spinal cord. CMS will consider these recommendations for 2028 implementation through proposed rulemaking anticipated in July 2027.
