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October 1, 2019

CMS' 2020 MPFS proposed rule draws more than 40,000 comments

Daily Briefing

    CMS' public comment period for the 2020 Medicare Physician Fee Schedule (MPFS) proposed rule ended last week, and the agency received more than 40,000 comments from hospital groups, insurers, and other industry stakeholders.

    Slide deck: The most important takeaways from the 2020 MPFS proposed rule

    The agency must now review the comments before releasing a final rule, which is expected to be published in November.

    Hospital groups praise E/M code changes, but other providers raise concerns

    Hospital and medical groups praised CMS' decision to roll back a provision in the 2019 MPFS final rule that would have consolidated the five-tier payment system for evaluation and management visits into one payment rate. In response to provider's concerns, CMS in the latest proposed rule decided to move back to the five-tier system for established patients and suggested moving to a four-tier coding system for new patients.

    The American Medical Group Association in its comments said, "CMS recognized that its earlier plan for [evaluation and management (E/M)] visits would have disrupted care patterns and may have created other unintended consequences," adding, "Having the separate codes helps acknowledge the difference in resources in treating patients with more complex care needs."

    The Medical Group Management Association similarly said CMS' proposal to maintain the five-tier payment system would avert unintended consequences, such as forcing "medical practices to reduce their Medicare patient volume or limit the medical issues addressed during one office visit due to lower reimbursement rates for more complex visits."

    However, hundreds of commenters raised concerns that the E/M change for physicians came at the expense of other providers, such as physical therapists, psychologists, radiologists, and social workers.

    For instance, one commenter took aim at the proposed 4% payment cut in 2020 for clinical social workers (CSWs), saying, the "nation can ill afford to implement disincentives to CSW participation in Medicare, given the skyrocketing growth of the Medicare population, many of whom live with anxiety, depression and other challenges that CSWs are uniquely qualified to address."

    In addition, a clinical psychologist, whose been a Medicare provider for 20 years, said CMS' proposed 7% reimbursement cut for psychologists could cause more providers to "opt out of the plan and many more Americans will lose access to the health and behavioral, psychotherapy, testing and supportive services that they desperately need."

    Another commenter said the proposed 8% cut for physical therapy services could exacerbate a shortage of physical therapy professionals.

    The Alliance for Physical Therapy Quality and Innovation similarly said, "If CMS wants to reach the stated goal of decreasing opioid use, access to physical therapy should be expanded—not cut."

    Hospital, provider groups praise new opioid payments

    Hospital and other provider groups also weighed in on ways CMS should implement opioid-related proposals.

    CMS proposed expanding Medicare coverage for opioid use disorder treatment service. Under the proposed rule, Medicare would pay opioid treatment programs (OTPs) for providing medication-assisted treatment (MAT) to beneficiaries with opioid use disorders. CMS also proposed creating a monthly bundled payment for counseling and management services involving MAT for beneficiaries with opioid use disorders.

    America's Essential Hospitals in its comment said, "CMS should ensure the proposed bundle accounts for the complex patient populations essential hospitals treat for (opioid use disorder) and ensure reimbursement for these services adequately covers all associated costs."

    The Federation of American Hospitals, meanwhile, said CMS should "consider how to coordinate those services that may need to be provided alongside those captured in the bundle that are important to the successful completion of the OUD treatment."

    Providers raise concerns about proposed MIPS changes

    Some providers groups raised concerns about CMS' proposal to change how providers report under the Quality Payment Program's Merit-Based Incentive Payment System (MIPS).

    CMS in the 2020 MPFS rule proposed increasing the minimum number of points clinicians must receive to avoid a negative payment adjustment under MIPS from 30 points in 2019 to 45 points in 2020, and 60 points in 2021. In addition, CMS proposed increasing "the additional performance threshold for exceptional performance to 80 points in 2020 and to 85 points in 2021."

    CMS also proposed:

    • Increasing the weight of MIPS' cost performance category to 20% in 2020, 25% in 2021, and 30% in 2022; and
    • Reducing the weight of MIPS' quality performance category to 40% in 2020, 35% in 2021, and 30% in 2022.

    CMS proposed the changes in response to provider criticism that the program is too complicated.

    However, some provider groups said the proposed changes do not go far enough to address their concerns with the program.

    The Alliance of Specialty Medicine said, "Most notably, the framework fails to truly deconstruct the silos that currently separate each performance category." The group added, "Instead, it simply attempts to connect the performance categories under a common theme but maintains a structure where each category still has a distinct set of measures/activities and a unique set of reporting and scoring rules" (Brady, "Transformation Blog," Modern Healthcare, 9/30; LaPointe, RevCycle Intelligence, 9/30; Finnegan, FierceHealthcare, 9/26).

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