CMS proposals are a 'missed opportunity,' industry groups say

Sweeping changes proposed by CMS on July 12 appear to be a mixed bag for healthcare providers, according to association groups, which see some of the changes as a missed opportunity to encourage value-based care.

The agency announced the proposals Thursday, taking aim at the Physician Fee Schedule payment policy and Quality Payment Program.

While some of the changes would likely provide benefits to physicians, such as the promotion and payment of virtual care and telehealth, other proposals were not met with enthusiasm by the healthcare industry.

Stakeholders have taken issue with the Quality Payment Program, which encompasses Advanced Alternative Payment models (APMs) and the Merit-based Incentive Payment System (MIPS), both which can enable participating providers to earn incentive for health outcomes and cost savings.

“CMS again is proposing policies that do not further the program’s intent and potential,” American Medical Group Association (AMGA) said in a statement about the proposed rule for the third year of the Quality Payment Program.

Specifically, AMGA sees the maintenance of a high low-volume threshold that will reduce payments to providers invested in value-based care initiatives. CMS added a new element to the low-volume threshold determination among its proposals and will allow clinicians who meet one or two elements to participate.

In MIPS, providers have the opportunity to earn an adjustment up to 7 percent of their Medicare Part B payments in 2021, based on their performance in 2019. However, CMS estimates the adjustment will be just 2 percent, according to AMGA. The association called the move a “missed opportunity.”

“As we enter the program’s third year, it is time for CMS to honor congressional intent and use MIPS to create value for Medicare,” AMGA President and CEO Jerry Penso, MD, MBA, said in a statement.

The QCP proposals included several other changes, such as expanding eligibility of MIPS to new clinician types; adjustments to episode and quality and cost performance measures, including a facility-based scoring option; other flexibilities for small-practice physicians.

CMS proposed to update physician fee schedule rates 0.25 percent in 2019 and proposed no changes to site-neutral payment policies. This maintains the 2018 payment rate providing nonexcepted hospital off-campus outpatient departments of 40 percent for those services. The 2019 proposed rate represents a cut from the 50 percent rate afforded in 2017.

“We remain disappointed that CMS continues its short-sighted policies on the relocation of existing off-campus hospital outpatient departments,” American Hospital Association (AHA) Executive Vice President Tom Nickels said in a statement Thursday. “These ‘site-neutral’ policies ignore the need for hospitals to modernize existing facilities so that they can provide the most up-to-date, high-quality services to their patients and communities. We also continue to urge CMS to improve its payment methodology to better account for the fact that the outpatient payment system includes many more services in its payment rates than the PFS.”

AHA also took issue with the 3 percent reduction in the drug payment add-on, which CMS states will lower out-of-pocket costs for prescriptions for seniors.

“We believe CMS should instead address the skyrocketing list prices of drugs directly with pharmaceutical manufacturers,” Nickels said.