AMA says Medicare payment schedule rule threatens patient access
Other groups criticized aspects of CMS' proposed rule, including MGMA, which said it would urge Congress to avert cuts to providers.
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The American Medical Association has criticized the new Medicare payment schedule proposed rule released last week by the Centers for Medicare and Medicaid Services, saying it fails to account for inflation in practice costs and "COVID-19-related challenges to practice sustainability."
The proposed 2023 Physician Fee Schedule (PFS) conversion factor is $33.08, a decrease of $1.53 from the 2022 PFS conversion factor of $34.61. This conversion factor accounts for the required update to the conversion factor for 2023 of 0%; the expiration of the 3% increase in PFS payments for 2022 as required by the Protecting Medicare and American Farmers From Sequester Cuts Act; and the required budget neutrality adjustment to account for changes in Relative Value Units.
In short, it amounts to a slight pay cut for providers. The AMA called the cut a "significant and damaging across-the-board reduction in payment rates."
"Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians," the organization wrote in response to the proposed rule. "We will be working with Congress to prevent this harmful outcome."
CMS' proposed rule seeks to expand access to behavioral health services, Accountable Care Organizations, cancer screening and dental care, with a focus on rural and underserved areas, the agency said late last week.
WHAT'S THE IMPACT: OTHER REACTIONS
Other organizations have also called the rule a mixed bag, including the Medical Group Management Association.
"MGMA is concerned about the potential impact of the proposed 3.75% reduction to the conversion factor due to budget neutrality requirements and will seek congressional intervention to avert the cut," the group wrote in a statement today.
However, MGMA praised other aspects of the proposed rule.
"We are pleased to see CMS proposing to pause the punitive phase of the Appropriate Use Criteria program set to begin in 2022 to give practices ample time to prepare following the COVID-19 public health emergency," the organization said. "MGMA is encouraged that CMS heeded our call to expand coverage for audio-only mental health services and views this proposal as a positive step to increase access to vulnerable populations that would otherwise go without care."
The Surgical Care Coalition, meanwhile, echoed the AMA's opinion that the updates to the conversion factor have failed to keep up with inflation. The result, the organization said, is that the conversion factor is only about 50% of what it would have been if it had been indexed to general inflation as it had been prior to 1998.
"While CMS is taking notable strides to improve health equity and access to care, today's proposed rule maintains the cuts to surgical care that Congress stopped last year," said Dr. David B. Hoyt, American College of Surgeons executive director. "These cuts harm the care patients need and deserve, which is the opposite of what CMS is trying to achieve. Without congressional action, surgical care faces a significant payment cut and threatens patient access to critical treatments and procedures. All patients deserve a healthcare system that invests in surgical care and does not create uncertainty year after year."
The American Medical Group Association, while lauding the delay to electronic ACO quality reporting, had concerns about another aspect of the Medicare Shared Savings Program. AMGA had recommended that the CMS finalize its proposal to let ACOs in the MSSP opt to remain at their current level within the BASIC glide path for an additional performance year. But the group opposed the requirement that ACOs deferring advancement skip a level in the glide path. An ACO that opts to halt its advancement because of the COVID-19 pandemic would jump ahead (i.e., Level A ACOs would move to Level C or Level D) but would not have the experience necessary to succeed in a level with higher risk, the group said.
"CMS created a glide path to taking on risk for a reason," said AMGA President and CEO Dr. Jerry Penso. "While we appreciate the flexibility CMS is offering ACOs due to the COVID-19 pandemic, we believe that ensuring ACOs can learn to take on risk more gradually is important for the move to value to succeed."
The effect of finalizing this "skip" policy could see an ACO abruptly and prematurely shift from a one-sided arrangement to a more advanced two-sided risk arrangement, he said. AMGA said it believes that a smoother transition to risk is essential to ensure the success of MSSP ACOs.
THE LARGER TREND
CMS released its proposed rule last week. To help address the acute shortage of behavioral health practitioners, the agency, in its 2022 CMS Behavioral Health Strategy, is proposing to allow licensed professional counselors (LPCs), marriage and family therapists (LMFTs), and other types of behavioral health practitioners to provide behavioral health services under general – rather than direct – supervision.
Also, CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient's primary care team.
The agency is additionally proposing to bundle certain chronic pain management and treatment services into new monthly payments; and is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
