Nov. 19, 2013
|The Honorable Max Baucus
Committee on Finance 219 Dirksen Senate
Washington, DC 20510
||The Honorable Dave Camp
Committee on Ways and Means
1102 Longworth House Office Building
Washington, DC 20515
|The Honorable Orrin G. Hatch
Committee on Finance
219 Dirksen Senate Office Building
Washington, DC 20510
||The Honorable Sander Levin
Ranking Member Committee on Ways and Means
1106 Longworth House Office Building
Washington, DC 20515
Dear Chairmen Baucus and Camp and Ranking Members Hatch and Levin:
RE: Medicare SGR Reform and Regulatory Relief Critical to Patient Access
The Coalition of State Medical Societies, representing 158,500 physicians and medical students for nine state societies, Arizona, California, Florida, Louisiana, Oklahoma, New York, North Carolina, South Carolina, and Texas, applaud the U.S. House and Senate for reaching across the aisle to create a much-needed plan to repeal the flawed Medicare Sustainable Growth Rate formula. We appreciate your concerted effort to take important steps to repair America’s health care system for seniors, persons with disabilities, and military families. We also appreciate your efforts to establish new payment systems that will help physicians keep their doors open to baby boomers and future Medicare patients.
The Coalition of State Medical Societies supports these components of the House-Senate proposal:
- Repeal the flawed Medicare SGR formula.
- Retain a fee-for-service program.
- Streamline current reporting programs and eliminate the current penalties related to PQRS, meaningful use, and the value-based modifier.
- Pay for complex chronic care management.
- Provide timely performance feedback for physicians.
However, to protect access to care for millions of Medicare patients and to ensure the sustainability of America’s health care system, these critical improvements must be made to the current House-Senate proposal:
- Provide appropriate annual updates to sustain physician practices.
- Allow options, extended timelines, assistance, and financial aid for any small physician practice that wishes to transition to new payment models, not only for those in certain locations.
- Instead of making incentive payments available only to specific physician practices or specific geographic areas, allow incentive payments for a variety of alternative payment models, including ones that DO NOT require physicians to assume full financial risk.
- Evaluate the cost-effectiveness of all reporting and incentive programs to determine whether they improve care, reduce total cost, or selectively penalize physicians who serve specific demographic or cultural groups.
- Before implementing any of the existing value-based modifier (VBM) measures and methods in a new value-based payment program, revise them so (1) the measures and standards used do not result in financial penalties for physicians when their patients do not comply with recommendations for testing and treatment; (2) physicians are not penalized for providing services to disadvantaged patients; (3) physicians are not penalized for noncompliance with obsolete or superseded guidelines and standards; and (4) both cost and quality measures are adequately risk-adjusted to eliminate the effects of poverty, poor educational attainment, and cultural differences.
- Put the costly, clinically irrelevant ICD-10 on permanent hold until ICD-11 or another usable replacement for ICD-9 is ready for widespread implementation. (HR 1701 by Poe; Coburn amendment to S 954)
- Reduce the regulatory burden imposed on physician practices.
Here’s why regulatory improvements must be considered in the House-Senate proposal:
Administrative costs in the U.S. private and public health care system consume an estimated $361 billion annually — 14 percent of all health care expenditures. Insurers and government health coverage require physicians’ practices to adhere to many complex program rules and policies. The U.S. Department of Labor’s Bureau of Labor Statistics reports that in 2011 physicians and other health care providers employed more billing and posting clerks than any other industry.
The attention afforded to administrative complexity in the management of government and private payer demands for documentation along with needless processes and procedures compete with the attention a physician should bring to legitimate quality initiatives and patient care.
The following are opportunities for the federal government to reduce significantly its contribution to administrative complexity and its related cost. The Coalition of State Medical Societies ask that Congress mandate CMS and the other relevant government agencies to strongly consider making these changes as quickly as possible, as every penny wasted today is one we will never recoup.
- Create a de minimis amount exception for the duty to return overpayments under threat of the False Claims Act as well as for Recovery Audits.
- Reverse the new mandate that provides that the ORDERING professional must be enrolled in Medicare for the REFERRED to professional to be paid for services. In other words, as it now stands a physician enrolled in Medicare can provide services to a beneficiary only to find he or she will NOT be paid because the ordering/referring physician was not enrolled in Medicare.
- Require, after an initial face-to-face encounter, CMS to pay for patient telephone and email consultations. (The current rules are too narrow in application to be workable.) This will help physicians treat patients without the expense of urgent care or emergency care visits. This also will provide for better care coordination.
- Require CMS to provide a free, modern method to submit Medicare and Medicaid claims electronically via the Internet. (Currently CMS is required to have software available for free submission. CMS uses the ancient SmartXfr software, which requires “terminal emulators” and transmission by MODEM and DIAL-UP through telephone lines. The connection is at -371-9510).
- Mandate that physicians be allowed to transfer their enrollment with one Medicare administrative contractor to provide medical services to other Medicare administrative contractors. This will eliminate unnecessary enrollment processes as it will prevent duplication of “dual” enrollment in multiple Medicare administrative contractors for those on state borders.
- Allow physicians to voluntarily opt out of Medicare for an indefinite time rather than requiring them to renew their opt-out documentation every two years. The government also should permit a physician to elect to rejoin Medicare and participate after one year has passed from the original election to opt out.
- Require a standardized, electronic format for physicians to obtain their entire fee schedule from a health plan. At this time, health plans do not provide their entire fee schedule to a practice nor do they provide it in a format that practices can easily convert into their practice management system. Some health plans don’t even provide it electronically. Physicians should be able to view that information on a health plan website and/or request that information in an electronic format.
- Health plans must, by law, offer EFT to physicians as an option in 2014. The Council for Affordable Quality Healthcare set up a one-stop process to enroll in EFT; however, many health plans are not willing to participate. It would be much easier for a practice if physicians could go to one website to select in which plans they want to enroll in EFT.
- Clearly define requirements on insurers for required first-dollar coverage of preventive care so that standards are uniform and enforceable.
- Update formats for electronic eligibility verification (270/271) to standardize all information required as a result of the Affordable Care Act.
- Reverse the presumption that a privacy breach has occurred (requiring notification of patients) in a breach analysis. This presumption was added in recently adopted regulations pursuant to HITECH and the ARRA, which will lead to many unnecessary notices to patients and cause needless alarm to patients along with unnecessary internal reviews.
- Eliminate the tracking and accounting for all disclosures of patient information (when an electronic medical record is used) and return to the previous mandate to track disclosures that are NOT for treatment, payment, or “health care operations.” (HITECH and ARRA added this new unfunded mandate.)
- Allow for the release of medical record copies in any reasonable format chosen by the health professional. This reverses a HITECH regulation that has required many to consider the purchase of new electronic medical record software (an update or change — neither of which are free). NOTE: When the government mandates changes in how electronic medical record systems work, vendors turn away from the needs of their customer (the physician) and focus on government compliance. It distorts the market.
- Repeal the requirement that a prescription is necessary for HSA/FSA reimbursement for over-the-counter drugs (ACA-related).
- Direct Recovery Auditors to focus only on practices with demonstrated outlying billing patterns, and provide due process and fair procedures for physicians who are subject to a Recovery Audit.
- Provide total cost-of-care data to help physicians effectively manage patient care and costs.