National healthcare associations reacted on Tuesday, Nov. 3 to the release of its calendar-year 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule on the part of the federal Centers for Medicare and Medicaid Services (CMS). As Healthcare Innovation’s report on Tuesday noted, the final rule held numerous provisions related not only to physician payment, but also to telehealth regulation and hospital price transparency rules.
The Washington, D.C.-based NAACOS (National Association of ACOs), which represents the accountable care organization community, said in a statement posted to its website, that “NAACOS is grateful that the Centers for Medicare & Medicaid Services (CMS) today is delaying by three years its overhaul of how accountable care organizations (ACOs) report and are measured on quality. This is one year longer than the agency originally proposed. For more than a year, NAACOS has cited numerous potential negative consequences to patient care among the many reasons why such a rapid shift to electronic clinical quality measure (eCQM) reporting was bad policy. We appreciate CMS listening to ACOs, providers, and the health IT vendor community on the need for more time and additional changes. We hope the agency uses the next three years to make further refinements to the policy to make it workable, fair, and an accurate representation of the quality of care ACOs provide. Ensuring high-quality care is a hallmark of ACO programs, so it’s important that any changes not create unintended consequences.”
Further, the association said, “NAACOS is also pleased to see the agency minimize administrative and financial burdens for repayment mechanism requirements by cutting in half the amount ACOs must secure as a financial guarantee when they move to risk-based models. We hope to see more of this type of burden reduction from the agency across other aspects of the MSSP. However, NAACOS is disappointed CMS didn’t use this regulation as an opportunity to make needed adjustments to ACO benchmarking and risk adjustment policies. Although CMS sought comment in the proposed rule on potential updates, ACOs will need to wait for changes to fix flawed program methodologies. We hope the agency will take action in rulemaking as soon as possible and not wait another full year. Specifically, NAACOS supports removing ACO-assigned beneficiaries from ACOs’ regional reference populations and capping risk scores in an ACO’s region at the same level of the ACO. Both of these changes, which are long overdue, will help create more fair and accurate spending targets for ACOs.”
Meanwhile, the Alexandria, Va.-based AMGA (American Medical Group Association) sent an email to the press in which the association said, “AMGA today called on Congress to act to prevent significant cuts to Medicare payments from taking effect next year. With the Centers for Medicare & Medicaid Services (CMS) finalizing a decrease in the conversion factor in the CY 2022 Physician Fee Schedule rule, Congress must intervene to ensure providers maintain their ability to deliver high-quality care to their patients.”
“Now that the decrease in the conversion factor is official, AMGA members need Congress to recognize the gravity of the situation,” Jerry Penso, M.D., AMGA’s president and CEO, said. “The decrease in the Medicare conversion factor, along with the looming sequester and PAYGO cuts, will undermine the ability of AMGA members to care for their patients.”
As the AMGA statement noted, “The Centers for Medicare & Medicaid Services (CMS) finalized a reduction in the physician fee schedule conversion factor by 3.75%, the same amount that Congress temporarily increased Medicare payments to help offset the effect of the COVID-19 pandemic. The conversion factor cut, however, is not occurring in isolation. Providers are currently facing the potential of up to a 10% cut to Medicare reimbursement at the end of the year. In addition to the 3.75% conversion factor cut, providers also are facing a 2% Medicare sequester and a 4% or $36 billion Medicare cut set to occur in January 2022 due to Pay-As-You-Go (PAYGO) offsets required by the $1.9 trillion COVID-19 relief package passed earlier this year. Left unaddressed, providers will see Medicare cuts of up to a 10% at the end of the year. Congress needs to act to prevent these cuts from occurring.”
In that regard, “Failing to prevent these cuts could result in significant challenges,” Penso added. “Our members will need to make hard choices, and will need to consider hiring freezes and layoffs, as well as service line eliminations. It’s a critical situation, and Congress needs to treat it as such.”
Don Crane, president and CEO of the Los Angeles-based APG (America’s Physician Groups), said this, in a statement: “APG is pleased to see several changes to the Medicare Physician Fee Schedule, particularly the extension of the CMS Web interface under the Medicare Shared Savings Program for an additional three years, and the delay of the increase in the quality performance standard for ACOs. Additionally, we are pleased to see CMS continue to support movement toward risk-based providers by revising the repayment mechanism arrangement policy and reducing the percentage used for determining the repayment mechanism amount by 50 percent. We also welcome a number of the changes to telehealth coverage, including the extension of certain telehealth services until 2023. In particular, these changes to telehealth coverage will greatly help many people with mental health and behavioral disorders by eliminating geographic and other barriers to treatment. APG members have been at the forefront of advocating for many of these policies and are gratified that CMS is moving toward making positive changes within the healthcare system,” Crane added.
Meanwhile, in a statement posted to its website, the Charlotte-based Premier Inc. reacted thus: “The Premier healthcare alliance appreciates that the Centers for Medicare & Medicaid Services (CMS) will delay the transition to new Medicare Shared Savings Program (MSSP) quality reporting requirements, as we recommended. However, we are concerned that CMS’ MSSP accountable care organization (ACO) measurement strategy fails to support the Innovation Center’s strategy refresh to move all Medicare beneficiaries into a total cost of care payment model by 2030. To achieve this vision, we must define the best approaches for assessing ACOs. We should not, as CMS’ policy requires, tie the ACO quality approach to fit within a Merit-based Incentive Payment System (MIPS) fee-for-service framework. Rather than placing undue burden on ACOs, CMS should focus on aligning value-based arrangements and quality reporting across payers.”
The Chicago- and Washington, D.C.-based American Hospital Association (AHA) also offered a mixed response. In a statement posted to the AHA’s website and attributed to Stacey Hughes, executive vice president, the AHA stated that “Today’s final Medicare outpatient rule contains a number of important policies that will help hospitals and health systems better provide care. We are pleased that CMS recognized the unique role that hospital outpatient departments play in caring for patients by rolling back two problematic policies it put forth last year. Reinstating the list of services that Medicare will pay for only when performed in an inpatient setting due to their medical complexity, and reinstating long-standing safety criteria for allowing procedures to take place in ambulatory surgical centers, is a win for patients’ safety, health and quality of care. However, we remain disappointed that CMS will continue deep payment cuts to 340B hospitals, which threatens their ability to care for their patients and communities and goes against Congress’ intent in establishing the 340B program nearly 30 years ago. These cuts are enabled by a lower court’s deference to the government’s inaccurate interpretation of the law, which is at the center of the legal issue the Supreme Court will review later this month at our urging. Continuation of these cuts will undoubtedly exacerbate the strain on 340B hospitals, especially as the COVID-19 pandemic continues.”
What’s more, the AHA said, “In addition, hospitals and health systems are deeply committed to helping patients access the information they need to make informed decisions about their care, including financial information. That said, we are very concerned about the significant increase in penalties for non-compliance with the hospital price transparency rule, particularly in light of the many demands placed on hospitals over the past 18 months, including both responding to COVID-19, as well as preparing to implement additional, overlapping price transparency policies. Finally, the AHA applauds today’s 2022 Physician Fee Schedule final rule for delaying the enforcement of the Appropriate Use Criteria program as well as expanding access to telehealth services, especially for behavioral health services.”
And the Chicago- and Washington, D.C.-based American Medical Association (AMA) on Wednesday morning sent to the press the following statement, attributed to Gerald E. Harmon, M.D., the AMA’s president: “While the American Medical Association (AMA) will thoroughly analyze the 2,400+ page rule, it is a reminder of the financial peril facing physician practices at the end of the year. The final rule includes a reduction in the 2022 Medicare conversion factor of about 3.85 percent. The AMA is strongly advocating for Congress to avert this and other looming cuts to Medicare physician payments that, overall, will produce a combined 9.75 percent cut for 2022. This comes at a time when physician practices are still recovering the personal and financial impacts of the COVID public health emergency. Congress is beginning to recognize that this financial instability could limit health care access for Medicare patients. The clock is ticking."
