Despite a handful of positive developments, the Texas Medical Association is objecting to a number of proposed changes to the 2021 Medicare physician fee schedule, including a payment-methodology change that would result in a payment cut for many physicians.
TMA submitted comments last week in response to the Center for Medicare & Medicaid Services’ (CMS) fee-schedule proposal, which also included changes to the Quality Payment Program (QPP) that TMA says would make an already complex program even harder to participate in.
Regarding payments, TMA said it supports changes in the fee schedule that “recognize the unduly low payments for physician office visits. However, CMS must also work with Congress to stop penalizing doctors with the current budget-neutral methodology.”
TMA agreed with CMS’ proposal to maintain the 2021 evaluation and management coding rules the agency finalized in the 2020 rule, and supported the 2021 proposal to permanently add nine Medicare telehealth codes. It also urged CMS to maintain the payment parity for telemedicine services that it introduced as part of the COVID-19 public health emergency, and asked the agency to continue allowing audio-only evaluation and management calls as covered telehealth services beyond the end of the emergency. Allowing coverage of those calls during COVID-19 had “greatly increased access to medical care” for seniors in rural areas, TMA noted.
But TMA says the current budget-neutral methodology is designed such that “when one specialty is paid appropriately for medical services rendered, others must be penalized.” TMA specifically singled out CMS’ proposal to cut the 2021 Medicare conversion factor by 11%, which will result in a payment decrease for many physicians.
“This action causes great harm to physicians and to access to care for Medicare patients,” TMA wrote. “CMS has consistently instituted systems that add significant cost and administrative burden to physicians. To ensure access to care for seniors, one of our more vulnerable populations, physician payments must increase and not decrease.”
As for the QPP’s Merit-Based Incentive Payment System (MIPS), CMS proposes to lower the scoring performance threshold for the 2021 performance year from the originally planned 60 points to 50 points. TMA advocated for maintaining this year’s performance threshold of 45 points, citing the ongoing impact of the COVID-19 pandemic.
TMA in its comment letter called it “absurd that the agency would make any changes to a performance threshold while physicians continue to care for patients in a pandemic,” and expressed concern about the program being a “constantly changing and moving target.” Medicine noted that it is “difficult, time-consuming (taking away from valuable patient time), and administratively burdensome for physicians and practices to keep up with the drastic changes and restructured framework for QPP participation.”
“Each ‘improvement’ the agency makes further complicates the program and significantly increases the burden on physicians. This year is no exception,” TMA wrote.
Medicine said the agency “would do well to continue recognizing the struggle physicians are under and how it continues even if policymakers lose interest or decide to focus on other topics their constituents desire. Physicians and their practices do not have this option. They still struggle to procure an appropriate amount of personal protective equipment to safely treat all patients. Additionally, since so many practices are financially unstable right now, many do not have the necessary staffing levels to compensate for the workload when one or more staff members become ill. Expecting physicians to meet and report on arbitrary measures that do not truly measure care quality during these difficult times is indeed misguided.”
In its comment letter, TMA details its support for a CMS proposal to delay for one year – until the start of 2022 – Medicare's requirement for electronic prescribing of controlled substances (EPCS). TMA “emphatically” asked CMS not to penalize physicians for noncompliance, saying penalties “have unintended consequences such as limiting access to care or physicians not prescribing needed medications to patients. CMS needs to understand why a small minority of controlled-substance prescribers do not use EPCS. It likely will be linked to volume. Those who regularly prescribe controlled substances probably have already upgraded their software to accommodate EPCS.”
CMS’ is expected to release its final 2021 fee schedule rule by Dec. 1.