Unless the federal government increases physicians’ Medicare payments and overhauls Medicare’s hassle-laden Quality Payment Program (QPP), access to health care for millions of American seniors and people with disabilities “is at risk,” the Texas Medical Association told Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.
“Medicare payments to physicians have stagnated for most of this century, and promised pay increases have vanished in the wake of cost-cutting actions by Congress and CMS,” TMA President David C. Fleeger, MD, wrote in a 57-page formal letter commenting on CMS’ latest round of proposed Medicare rules. “Meanwhile, the administrative burdens and costs of participating in Medicare have increased year after year.
“This is an unsustainable trend.”
The comments, compiled by the physicians and staff of TMA’s Council on Health Care Quality, Council on Socioeconomics, and HIT Committee, came in response to CMS’ proposed 2020 Medicare fee schedule and yet another batch of proposed changes to the QPP. The agency published the proposed rules in the Federal Register on Aug. 14. CMS will issue a final rule later this fall, with explanations of which stakeholder recommendations it decided to accept or reject. It will take effect Jan. 1.
“Like you, our goal is to ensure all Medicare beneficiaries receive high quality, cost-effective care,” Dr. Fleeger wrote. “That cannot happen if our Medicare patients lack appropriate and timely access to physicians of all specialties.”
One bright spot in the proposed rules is the final elimination of CMS’ plans to drastically change Medicare coding and payment for evaluation and management (E&M) services. Last year, in its proposed fee schedule for 2019, CMS announced it was collapsing outpatient E&M coding levels 2 through 5 into one payment level, with an amount projected to sit roughly halfway between levels 3 and 4. TMA, the American Medical Association, and most of organized medicine cried foul, and CMS postponed the change for a year to “allow for continued stakeholder engagement.”
In the latest proposed rule, the agency announced it is abandoning that plan entirely. “CMS is making the right decision,” Dr. Fleeger wrote.
Most of the 63 separate recommendations in the TMA comment letter continued the association’s multi-year battle to streamline and simplify QPP for physicians. “We remain disappointed in CMS’ highly flawed and complex program that a great majority of Texas physicians believe lacks appropriate methodologies, uses poor measures, and falls short of benefiting their patients,” Dr. Fleeger wrote.
Highlights of the TMA recommendations, as summarized by Dr. Fleeger, include:
- “TMA strongly encourages CMS to correct the problems with the geographic practice cost index (GPCI) calculations and advocate for Congress to permanently extend the 1.0 floor to states that do not have a permanent floor. We also recommend CMS revise the GPCI payment localities using metropolitan statistical area data to determine boundary changes.
- “TMA strongly opposes CMS expanding its authority to encroach on state medical boards’ responsibility and authority to regulate physicians and protect patients.
- “TMA is pleased CMS did not propose to decrease the low volume threshold, which would have required more physicians to participate in the Merit-Based Incentive Payment System (MIPS). TMA urges CMS to increase the low volume threshold for the 2020 performance year and beyond, and to exempt small practices from required participation in MIPS.
- “TMA applauds and fully supports CMS’ proposal to establish a physician-friendly policy that will allow physicians an opportunity to have their performance category reweighted when data errors are made by vendors or others.
- “TMA urges CMS to revamp its policies and protocols to correct the payment delays and administrative delays and errors that have frustrated those physicians who are dedicated participating in QPP and its various components.
- “TMA urges CMS to eliminate QPP measures based on actions or outcomes that are not in physician control, as well as those measures that penalize physicians who disproportionately treat patients from disadvantaged populations.
- "MIPS Value Pathways (MVPs) should be defined using TMA’s recommended guiding principles.
- “CMS should prioritize physician-led models of care and advanced APMs (alternative payment models) that offer participation opportunities for physicians in all specialties and practice sizes.”