July 18, 2017
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AMA, ACP, AAFP applaud CMS update of physician fee schedule

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In separate responses to the physician fee schedule proposed rule released by CMS, the AMA, ACP and American Academy of Family Physicians noted numerous positive changes that have the potential to improve patient care and save taxpayer dollars, including a request for information on regulatory relief, expansion of the Diabetes Prevention Program, consolidation and modernization of the legacy value-based payment systems and delayed implementation of appropriate use criteria.

“The annual physician fee schedule update is a chance for CMS to modify Medicare policy to ensure the best possible treatment options for patients,” David O. Barbe, MD, president of AMA said in a press release. “The AMA is encouraged by many of the proposed changes and applauds the Administration for working with the AMA to address physician concerns. We will submit formal comments to CMS before the final rule is released later this year.”

Specifically, the AMA, ACP and American Academy of Family Physicians (AAFP) praised CMS’ proposal to invite the public to comment and offer ideas on regulatory, subregulatory, policy, practice and procedural changes to reduce administrative burdens imposed on clinicians. The associations are encouraged by CMS’ acknowledgment of the importance of lowering unnecessary burdens for clinicians, other providers, patients and their families, as well as its action to solicit comments and request information and its openness to revisions.

The AMA also commended CMS’ action to expand Medicare Diabetes Prevention Program coverage to patients at risk for type 2 diabetes who are covered by Medicare. Access to an evidence-based Diabetes Prevention Program will be guaranteed for at-risk seniors and individuals with disabilities to help reduce risk factors and prevent or delay the progression to type 2 diabetes, according to the AMA. Previously, the AMA noted concerns that the payment model was too restrictive, and is now applauding CMS’ efforts to address its concern. In the new proposal, CMS will provide more flexibility in maintaining patient engagement and attendance to Diabetes Prevention Program providers by offering performance-based payments if patients achieve weight-loss goals over a longer period, according to the AMA. In addition, the expansion highlights a 3-year demonstration project of the YMCA, which was estimated to save $1.3 billion, according to the AMA.

The AMA, ACP and AAFP applauded CMS’ efforts to retroactively modify the 2016 Physician Quality Reporting System (PQRS), Meaningful Use and Value-Based Payment Modifier requirements to mirror Merit-based Incentive Payment System (MIPS) policies that decrease physician penalties in 2018. The associations also praised CMS for reducing the number of PQRS quality reporting requirements for MIPS to six measures, thus allowing some clinicians to avoid penalties and better align PQRS with MIPS in their transition.

Furthermore, the AMA and AAFP are pleased with CMS’ decision to delay the implementation of a program that would require physicians to consult appropriate use criteria before receiving payment for advanced imaging services. The requirement will be postponed until 2019 which will allow for a year of testing where consultation should not be mandatory, according to the AMA and AAFP.

“As a practicing primary care internist myself, I am greatly encouraged that CMS is proposing substantial improvements to help me and my colleagues provide coordinated, patient-centered, high-value and team-based care to our patients,” Jack Ende, MD, MACP, president of ACP, said. “We look forward to providing CMS with detailed comments to support these improvements while recommending other changes to strengthen primary care.”

The ACP also stated its support for CMS’ proposal to marginally increase the conversion factor, but noted, as did AAFP, that it would prefer a full misvalued code target to avoid an across-the-board reduction in the fee schedule.

“Reforming the physician payment system will unfold over time,” John Meigs, Jr., MD, president of AAFP, said. “As CMS moves to replace payment for individual procedures with payment for value and quality of care, we remind the agency that it’s important to strengthen the primary medical care that supports the system-wide reforms taking place today and for years to come.”

Disclosure: Barbe is the president of AMA. Ende is the president of ACP. Meigs is president of AAFP.