While applauding a Medicare proposal to continue offering telehealth flexibilities, the Texas Medical Association objected to several other proposed pieces of the 2022 Medicare physician fee schedule, foremost a pay cut for many physicians serving that patient population, especially during a pandemic.
TMA submitted comments earlier this month in response to the Centers for Medicare & Medicaid Services’ (CMS’) fee-schedule proposal, which also included changes to the Merit-Based Incentive Payment System (MIPS), a participation track in the Quality Payment Program (QPP). TMA said the proposed MIPS adjustments would make the already-complex track even more confusing and would exacerbate physician burnout.
TMA raised “grave concerns” in the comment letter about the current budget-neutrality requirement with Medicare physician payments, which mandates that any payment increases or decreases be offsetting. That “can lead to arbitrary reductions in payment unrelated to the increasing cost of providing care,” TMA wrote.
Medicine particularly pointed to CMS’ proposal to cut by 3.75% the Medicare conversion factor, a multiplier used in the calculation of payment rates for services. If finalized, this cut could prove “financially disastrous for physician practices,” in combination with already-low Medicare payments and other regulations. As a result, TMA called on CMS to work with Congress to prevent these cuts from occurring and to address the budget-neutrality requirement.
Amarillo family physician Rodney Young, MD, chair of TMA’s Council on Socioeconomics, says successive Medicare pay cuts have affected physicians more than other players in the health system, creating an unsustainable imbalance.
“Doctors can’t be the only entities in the health care system responsible for balancing Medicare costs,” he said.
TMA also pleaded with CMS to minimize changes to MIPS and to delay increasing the program’s cost category weight – from the current 20% to 30% – until the pandemic is over. Such updates are “increasingly burdensome and clinically irrelevant” hoops through which physicians are forced to jump in exchange for incentive payments or to avoid additional financial penalties, according to the letter.
“The complexity associated with the administration side is challenging enough without the frequency of the moving target,” Dr. Young said.
Relatedly, CMS’ proposal included changes to the QPP to promote the adoption of alternative payment models, the other participation track in the program. Those models are an attractive option to participate in QPP given the constant stream of changes to MIPS and its increasingly punitive aspects. TMA encouraged CMS to focus on the development of voluntary, physician-led alternative payment models instead of pursuing MIPS Value Pathways, a reporting framework that CMS is developing.
Piling on, CMS’ proposal would require physicians to retain patient health information indefinitely starting with visits on or after Jan. 1, 2016, which medicine’s letter described as infeasible. Instead, TMA encouraged CMS to adhere to 21st Century Cures Act requirements and heed state medical record retention laws. In Texas, physicians typically must retain adult medical records for seven years from the date of last treatment, according to the letter.
Finding a bright spot in the 1,700-plus-page draft rules, TMA endorsed CMS’ plan to retain all services added to the Medicare telehealth services list until the end of 2023. While praising the flexibility the telehealth provisions offer during the ongoing COVID-19 pandemic, TMA also encouraged CMS and Congress to consider payment parity for services provided via telehealth with services provided in person.
“Patients will now expect telemedicine visits when they’re appropriate,” TMA wrote. “Physicians must have the flexibility to decide whether to see their patients via telehealth or in person without unnecessary and disconnected pricing initiatives.”
CMS is expected to release its final fee schedule rule in early November.