Medicare & Medicaid

Physicians call for changes to Medicare payment policy proposals


New proposed rules from the Centers for Medicare & Medicaid Services (CMS) would impact many aspects of physician payment and federal regulatory programs, but many of these changes are not for the better. In a letter sent last week, the AMA urged the agency to make revisions to avoid negative effects on physicians and patients.

Among the many topics addressed in the 64-page letter were these issues of concern:

Expanding the value-based modifier (VBM)

CMS wants to expand the VBM to all physicians and increase the potential penalty from 2 percent to 4 percent. The AMA opposes any increase in the penalty and noted that under CMS’ proposal, some practices would be vulnerable to payment cuts from the various Medicare programs totaling 11 percent in 2017.

The AMA, which has also called for repeal of the VBM, is pressing CMS to avoid a “rapid and risky expansion” where “some of Medicare’s sickest patients could lose access to their doctors, some physicians could be driven out of business and the government will have diverted scarce resources from other payment and delivery reforms that have a far better chance of achieving a more value-based health care system.”

Including CME activities in Sunshine Act reporting

The AMA also weighed in on CMS’ proposal to include certain types of continuing medical education (CME) in the Physician Payments Sunshine Act, which requires public reporting of physicians’ financial interactions with medical device and drug manufacturers. Adding CME activities to this reporting would “chill physician participation in independent [continuing education] programs,” the letter said.

The AMA and 112 specialty and state medical societies have been calling for CMS to eliminate this proposal and ensure physicians have enough time to review their data.

Reporting and paying for chronic care management

The agency said it will begin paying physicians for chronic care management next year, which is positive. However, CMS proposes using temporary “G” codes, which would require physicians to report these services every 30 days, rather than the new CPT® code that would simplify reporting to once per calendar month. The AMA is urging CMS to accept the CPT’s “monthly” structure, which is administratively simpler, and to adopt practice expense values, recommended by the AMA/Specialty Society Relative Value Scale Update Committee (RUC), that more adequately reflect the clinical resources required to deliver chronic care management.

Eliminating global service packages

CMS wants to transition the more than 4,200 services that have 10- and 90-day global periods to zero-day global codes by 2017 and 2018, respectively. This change “would not accurately account for physician work, practice expense [or liability] risk for services performed within the current surgical global period,” the letter said. The change also would place substantial administrative burden on physicians.

Instead, the AMA urges CMS to work with the RUC and the CPT® Editorial Panel to ensure physicians will be accurately paid for patient care services that currently don’t have separate coding or payment.

Quality reporting

CMS proposes to increase the number of measures needed to avoid a 2 percent payment penalty under the Physician Quality Reporting System from three to nine and to simultaneously reduce the measures available for reporting.  The letter opposes the increase in measures “due to the unavailability of meaningful measures relevant to every specialty and the dramatic reduction of measures available to report.”

The AMA also urged CMS to make the PQRS program more streamlined and stable, asking the agency not to change requirements on a yearly basis. In addition, physicians who successfully participate in PQRS or are successful demonstrators under the electronic health records meaningful use program should be counted as satisfying both programs, the letter said.

Other issues discussed in the letter include:

  • A revised timeline for reviewing new, revised and potentially misvalued services. This proposal would significantly slow implementation of important CPT code updates and adjustments to the values of physician services. In addition to the comments in this letter, the AMA and 70 medical specialty associations submitted formal comments on the revised timeline in a separate letter dealing with this issue alone. Read more in a recent AMA Wire® post.
  • Revisions to the clinical lab fee schedule.
  • The burdensome opt-out process for physicians who wish to participate in private contracting.