The leaders of the Alexandria, Virginia-based American Medical Group Association (AMGA), which represents large multispecialty medical groups, on Oct. 5 sent Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS) a letter, asking her to reconsider some elements in CMS’s proposed Physician Fee Schedule for calendar year 2021. They focused on dissatisfaction with such areas as the agency’s proposed revaluation of evaluation and management (E/M) reimbursement for physicians, as well as with proposed changes to the Medicare Shared Savings Program (MSSP) that could imperil some payment advantages for medical groups participating in the program. The letter was signed by Jerry Penso, M.D., the association’s president and CEO.
Later in the day on Monday, the leaders of the Charlotte-based Premier Inc. health alliance also weighed in.
The press release that AMGA published on Oct. 5 to notify the public of the letter quoted Dr. Penso as stating that, “More than anything right now, our members need certainty. CMS’ plan unfortunately would add yet another change into a system that is dealing with an upheaval in how care is provided. From canceled elective procedures to a rapid shift to telehealth, group practices are working to not only get their bearings and recognize what care delivery models are most effective for treating patients during this pandemic, but also to understand what practice patterns will be like after COVID-19,” Penso stated in the press release. “Changes to code values just add more uncertainty.”
The letter, which can be read in its entirety here, had several areas of focus. The press release noted that, “In their comments to CMS, AMGA specifically recommends that the agency not move forward with its proposal to revalue a number of office and outpatient evaluation and management (E/M) visits. The reduction in the conversion factor needed to maintain budget neutrality represents a significant decrease in support for Medicare providers and would decrease payments for a number of providers. AMGA also is opposed to CMS’ proposals for the Medicare Shared Savings Program (MSSP), such as a proposed reduction in the number of quality measures that accountable care organizations (ACOs) will report and the elimination of the pay-for-reporting year for ACOs in their initial contract. CMS also would revise the quality performance standard so it creates an “all-or-nothing” ability for an ACO to earn shared savings. AMGA opposes these changes, which increase the influence of any one measure on an ACO’s ability to earn shared savings. These significant proposals come shortly after CMS finalized a new structure to the ACO program in 2018.”
In the letter, AMGA made several key recommendations:
> Payment for Evaluation and Management (E/M) Services
CMS should not finalize its proposal to increase the relative value units (RVUs) for the evaluation and management (E/M) codes due to the significant decrease in the conversion factor. This decrease, when combined with the effects of the novel coronavirus 2019 (COVID-19) pandemic, would create significant financial hardship for various specialties within AMGA member groups.
> Additions to the Telehealth List
o AMGA believes that telehealth will be a core service moving forward and supports CMS’ efforts to add additional codes to the Medicare telehealth list.
o AMGA supports the proposal to add a number of codes to the telehealth list on a Category 1 basis.
o While outside the scope of this proposed rule, AMGA recommends that CMS exercise all administrative authority at its disposal to waive the telehealth geographic and originating site requirements.
> Continuation of Payment for Audio-Only Visits
o AMGA strongly recommends that CMS permanently add payment for audio-only services.
> Medicare Shared Savings Program
o APM Performance Pathway (APP): While AMGA supports burden reduction and streamlining quality reporting for entities participating in value-based models, we are concerned about the extent to which CMS is reducing the Medicare Shared Savings Program (MSSP) quality measure set. CMS should not implement the APP as proposed and should work to implement a mix of outcomes and process measures that align across various programs. Additionally, AMGA does not support CMS’ proposal to end the quality “phase-in” (eliminating the pay-for-reporting year) with the implementation of the APP.
o CMS should not apply the quality performance standard to shared savings the way it is proposed. ACOs should not be ineligible to share in savings if they do not meet the more stringent quality performance standard.
> Quality Payment Program
o APP: AMGA supports the use of the APP as a scoring pathway for Merit-based Incentive Payment System (MIPS) alternative payment models (APMs), as long as CMS maintains its other reporting mechanisms in the process.
o CMS Web Interface: AMGA opposes the elimination of the CMS Web Interface, as doing so would impose undue burden on ACO participants.
o Cost Performance Category: AMGA recommends that there be more modeling on the impact of adding the costs associated with providing these telehealth services to the previously established cost measures.
o Quality Measure Benchmarks: AMGA supports CMS’ intended approach of using performance period benchmarks for the calendar year (CY) 2021 performance period.”
Premier Inc. weighs in
Also on Monday, the leaders at the Charlotte, N.C.-based Premier Inc. health alliance weighed in, via a public statement.
As Monday’s statement said, “Premier submitted comments on the Centers for Medicare & Medicaid Services (CMS) CY 2021 physician fee schedule (PFS) and outpatient prospective payment system (OPPS) proposed rules.
In its OPPS comment letter, Premier:
1. Urged caution as CMS looks to modify its Inpatient-Only (IPO) List and ambulatory surgical center Covered Procedures List and take proactive steps to mitigate the effects of these changes, particularly for alternative payment models, if finalized.
2. Opposed the proposed increased payment cuts to 340B drugs to ASP -28.7 percent.
3. Supported a more transparent and replicable methodology for Hospital Star Ratings and recommended improvements, including steps to account for more social risk factors and establishing star rating thresholds through annual rulemaking for the upcoming year.”
Further, “In response to the PFS proposed rule, Premier:
1. Commented on proposed changes to the Medicare Shared Savings Program (MSSP), including voicing support for: 1) reducing the number of measures but delaying significant changes to the MSSP quality standard until 2022 due to the PHE; 2) giving ACOs flexibility in reporting mechanisms; and 3) raising the quality performance threshold and allowing ACOs that meet the standard to receive full shared savings.
2. Supported continuing to include many of the services added during the public health emergency (PHE) on the telehealth list; expanding the list and continuing coverage and payment for audio-only telephone E/M services; and immediately allowing broad telehealth flexibilities for APMs.
3. Supported making workforce flexibilities granted during the public health emergency permanent.”
And, Premier made the following statements, with regard to “the Quality Payment Program:
1. Opposed adding the APM Performance Pathway (APP) as a new option for the Merit-based Incentive Payment System (MIPS) reporting and scoring and terminating the MIPS-APM scoring standard.
2. Urged CMS to commit to pay the Advanced APM incentive payment by 6/30 in future years.”
