Proposals from CMS encouraging, but congressional action needed to prevent cuts in Medicare spending from going into effect on Jan. 1
Oct. 1, 2021 (ACP) – The American College of Physicians has carefully reviewed proposed changes to the Medicare Physician Fee Schedule and Quality Payment Program (QPP) for 2022 and submitted comments to the Centers for Medicare & Medicaid Services (CMS) acknowledging positive aspects of the proposed revisions but asking for more to be done to protect patients and physicians.
“We're encouraged on many fronts by the proposals put forward by CMS, but there are many opportunities for improvement,” said Shari Erickson, ACP senior vice president for governmental affairs and medical practice. “We're making sure that CMS hears our perspective. Fortunately, ACP is a respected and trusted resource, and our perspective matters to those who will make the final decisions in the coming weeks.”
On Sept. 13, ACP sent a 59-page letter about the fee schedule and QPP to Chiquita Brooks-LaSure, CMS administrator. ACP highlighted several high-priority recommendations that will “help to promote both access to affordable care for Medicare patients and health equity, while supporting physicians in their ability to deliver innovative care and protecting the integrity of the Medicare trust funds,” ACP wrote in the letter.
Here's a closer look at the ACP recommendations:
- Congress must stabilize the Medicare physician payment system.
Last year, Congress prevented massive cuts in Medicare spending from going into effect. But the move was only temporary. If legislators do not act by the end of this year, significant cuts will go into effect on Jan. 1, 2022, via a decreased conversion factor.
ACP has joined other medical societies to urgently push for a fix. “This is not something that CMS can directly address, but we're continuing to remind them that it is of significant concern to us,” Erickson said. “We are hoping that Congress will be able to help the agency to be able to address this issue for the coming year.” - Critical care visits should not be bundled into global surgery payments.
“ACP strongly disagrees with the CMS proposal to bundle critical care visits into global surgery payment,” the letter states. “The College believes that the Agency's policy implies that the clinician work for such vital service visits is not the same when performed in a surgical global period, which is an inaccurate position.” - Payments should be expanded for services using audio-only communication technology.
“CMS proposed to continue to maintain coverage for audio-only visits, but only for mental health,” Erickson said. “We're advocating that they go beyond that through at least the end of 2023 to allow more time for study of the use of audio-only and audio-visual visits. There are so many patients who don't have access to an audio-video platform, are uncomfortable using it, or don't know how and don't have assistance.” - Virtual supervision should be allowed permanently.
CMS has allowed supervisors more flexibility to oversee clinicians via virtual means during the pandemic. “We're proposing that they maintain that permanently and allow supervisors to make their own decisions about whether they're able to supervise clinicians virtually,” Erickson said. - Virtual check-in code policies should be revised.
“ACP does not agree that the establishment of G2252 is the solution to providing an alternative to telephone E/M [Evaluation and Management] visits,” ACP wrote in the letter. “Once again, rather than adopting a substitute, the College strongly recommends that CMS maintain pay parity between telephone E/M claims and in-person E/M visits and between all telehealth and in-person visits even after the PHE [public health emergency] is lifted. This extension should last at least through the end of 2023 with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits.” - Mandatory Merit-based Incentive Payment System (MIPS) Value Pathway (MVP) plans should be pulled back.
“ACP opposes CMS’ proposal to make MVP participation mandatory starting in PY2028,” the letter states. “We strongly urge CMS to ensure that MVP participation is voluntary and that physicians, group practices, and subgroups maintain the option to participate in traditional MIPS. Also, while the ACP supports CMS allowing multi-specialty groups to create subgroups for MVP reporting, the College does not support CMS making it a requirement for the 2025 performance year and beyond. Further, ACP does not support retiring ‘traditional’ MIPS, nor do we think it is necessary.”
As Erickson put it, “if they make MVPs appealing, less burdensome and more relevant to people's practices, they will naturally be moving to those.”
Typically, CMS releases a finalized fee schedule by the end of October, Erickson said, but because the proposed rule was released later than usual it may push that date into November.
