Payment & Delivery Models

Move to MIPS may come with regulatory relief

The phasing in of Medicare’s Quality Payment Program (QPP) includes the phasing out of its “legacy” value-based payment system, and the 2018 Medicare Physician Fee Schedule proposed rule includes details on how the Centers for Medicare and Medicaid Services (CMS) plans to get this done.

“CMS listened to the AMA and physician community to make retroactive modifications to the 2016 Physician Quality Reporting System (PQRS), Meaningful Use (MU) and Value-Based Payment Modifier (VM) requirements to reflect the policies in the Merit-based Incentive Payment System (MIPS)—reducing penalties for physicians in 2018,” an AMA news release states.

The proposal also seeks to address concerns for laboratories, including physician office-based labs, to collect and report data required by the Protecting Access to Medicare Act of 2014 (PAMA) and with the law’s mandate to consult appropriate-use  (AUC)criteria before ordering advanced imaging services.

Additionally, the proposal includes a request for suggestions on how CMS can reduce physicians’ administrative burdens. The move by CMS to consolidate and streamline the legacy value-based systems was positively received.

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PAMA also included a requirement that, before ordering an advanced imaging test, health professionals must use a qualified clinical decision support mechanism (CDSM) to review the applicable appropriate use criteria for the test about to be ordered and report consultation information on the corresponding Medicare claim. 

This requirement was set to take effect Jan. 1, 2018. In response to concerns raised by the AMA and other physician organizations, CMS is proposing to push that back one year and to consider 2019 a “testing and education” year.

CMS acknowledges that this “proposal substantially lags the statutory requirements,” but explains that the “delay in the statutory timeline is necessary to maximize the opportunity for public comment and stakeholder engagement, also a statutory requirement, and allows for adequate advance notice to practitioners, beneficiaries, AUC developers and CDSM developers.”

CMS also asks for feedback on further delaying the start date of the program and extending the testing and education period.

“It is important to receive comments that help us understand the current readiness of stakeholders,” CMS states in a fact sheet on the proposed rule.

Feedback sought on new lab law rule

Additionally, PAMA included provisions which the CMS proposed rule describes as requiring “extensive revisions” to Medicare payment, coverage and coding of clinical diagnostic laboratory tests. The AMA and other physician organizations noted problems practices were having with data collection and reporting schedules.

“The clinical laboratories that are on the front lines of providing services directly to their patients, physician office-based laboratories (POLs), are not able to meet the reporting deadline, in part due to the difficulties created by the fact that most of the data collection period started prior to the issuance of the final regulation specifying the data collection reporting requirements and collection period,” the AMA and six other organizations wrote in a March 30 letter to CMS Administrator Seema Verma. “In addition, we have strong concerns that the current data collection and reporting requirements, as well as the method for pricing applicable tests on the Medicare CLFS, will jeopardize the availability of clinical testing and patient access to these services in the setting where patients receive most of their medical care.”

CMS went on to “exercise enforcement discretion” in response to the AMA and other stakeholders feedback that there was not enough time meet the reporting requirements of the new law. In the proposed rule, CMS asks for feedback on problems physicians and laboratories faced with the reporting system and whether guidance offered by the agency was useful.

CMS invites “national conversation”

CMS proposal put out a general request for information seeking suggestions on how on how it can reduce physicians’ administrative burdens.

Physicians and others can also respond to the CMS invitation for ideas on a range of issues, including: payment-system redesign; elimination or streamlining of reporting, monitoring and documentation requirements; aligning Medicare processes with those from Medicaid and other payers; support of the patient-physician relationship; and facilitation of individual preferences.

“We would like to start a national conversation about improvements that can be made to the health care delivery system that reduce unnecessary burdens for clinicians, other providers, and patients and their families. We aim to increase quality of care, lower costs, improve program integrity, and make the health care system more effective, simple and accessible,” the CMS states in the proposed rule. “We would like to take this opportunity to invite the public to submit their ideas for regulatory, subregulatory, policy, practice and procedural changes to better accomplish these goals.”

In a statement, the AMA welcomed “this positive step by the CMS,” which the Association said came “after extensive discussions with the administration” about regulatory relief. 

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