THE VALUED VOICE

WHA Comments Submitted on Physician Fee Schedule Proposed Rule

Last week, WHA submitted comments on CMS’ proposed rule on the Physician Fee Schedule (PFS), Quality Payment Program, and the Medicaid Promoting Interoperability Program. The proposed rule contains many positive changes to streamline Evaluation and Management (E&M) documentation, which WHA strongly favors. However, these changes are counterbalanced by a proposal to consolidate E&M reimbursement categories, which WHA strongly opposed based on feedback from our members. The rule also modifies parts of Medicare’s Quality Payment Program as well as the Medicaid Promoting Interoperability Program. While WHA welcomes many of these changes, we also commented that some of the proposals are premature. This article summarizes our comments on each of these topic areas.

• Streamlining E&M documentation: WHA expressed strong support for CMS’ proposals to streamline E&M documentation. Reducing physician burnout is a top advocacy priority for WHA. Much of this burnout results from the heavy load of documentation within an electronic health record (EHR) that is required for reimbursement. Specific rule provisions that accomplish this goal include removing redundancy in E&M visit documentation when that information is already in the patient record; eliminating extra documentation requirements for home visits; eliminating the prohibition on billing same-day visits by practitioners of the same group and specialty; and reducing teaching physician documentation requirements for E&M services. WHA also told CMS that it favors a phase-in period for these documentation changes in 2019 to allow clinicians to acclimate to the changes, with full implementation in 2020 at the earliest. ​
• Consolidating E&M Payment Amounts: WHA expressed strong opposition to CMS’ proposal to consolidate the current five E&M reimbursement levels into two levels. The rule would maintain E&M level 1 and consolidate levels 2 through 5 into one level. Member feedback to WHA indicated that this change will financially disadvantage physicians who see a more complex patient panel, and we indicated this in our letter. 
• Merit-Based Incentive Payment System (MIPS) changes:  
  • WHA supported the proposed inclusion in MIPS of new categories of eligible clinicians in the quality payment program for CY 2019 (occupational therapists, physical therapists, clinical social workers, and clinical psychologists). However, WHA expressed concerns about the relationship of these additional clinicians to the Promoting Interoperability (PI) performance category. WHA expressed support for adding those clinicians who provide 200 or less covered professional services per year under the PFS to the low-volume threshold. 
  • WHA opposed the following changes to MIPS:  WHA opposed increasing the cost category weight from 10% to 15% and urged CMS to maintain the cost category at 10% for at least the 2021 payment year until clinicians have experience with a correct mix of cost measures. WHA also opposed adding the eight new episode measures to the MIPS cost category. WHA supports endorsement of quality measures by the National Quality Forum before their incorporation into MIPS and the proposed new cost measures have not received that vetting. 
• MIPS Promoting Interoperability Performance (PI) Category: WHA supported several proposed changes to the PI Performance Category, including finalizing a 90-day reporting period for the MIPS PI performance category in 2020. WHA supported this proposal as providing flexibility for MIPS eligible clinicians seeking to demonstrate meaningful use of certified EHR technology. WHA also supported finalizing the proposed scoring methodology for the MIPS PI performance category, because it would align the scoring methodology for the MIPS PI performance category with the scoring methodology for the Medicare PI Program. WHA also supported removal of four measures from the PI category. WHA recommended against finalizing two proposed opioid related measures: “Query of PDMP” and “Verify Opioid Treatment Agreement,” as they are premature and not supported by any standards or certification criteria. WHA also recommended against finalizing additional public health reporting requirement, as it creates additional reporting burdens for MIPS eligible clinicians.
• Advanced Alternative Payment Models (APMs): WHA supported extending the 8% revenue-based risk standard for MIPs through 2024 and supported the proposal that Qualified Payer determinations be made at the individual or Taxpayer Identification level. WHA expressed opposition, at this time, to increasing the requirement relating to the use of certified electronic health records technology (CEHRT) from 50% of eligible clinicians in each APM entity in 2018 to 75% in 2019.  
• Physician Technical Advisory Council (PTAC): The PTAC was established under the MACRA to provide a process for stakeholders to analyze and develop new APMs for the QPP. In its comments, WHA strongly urged CMS to create improved pathways to approved Medicare Part B Advanced APMs with better coordination with the PTAC. 
• Telehealth changes: WHA expressed support for many of the telehealth changes proposed in the rule as they would expand Medicare beneficiary access to health services. These changes include permitting payment for “virtual check-ins,” remote evaluation of pre-recorded patient information, interprofessional internet consultations, and chronic care remote physiologic monitoring.  
• Hospital Conditions of Participation Revisions: In response CMS’ potential future rulemaking to revise the hospital Conditions of Participation, WHA recommended CMS not proceed with these revisions.