Industry groups speak out against CMS's physician payment proposals

As CMS is proposing several changes to the physician payment schedule, some industry groups are speaking out about the proposals.

The American Medical Group Association was among the 170 groups that sent a letter to CMS Administrator Seema Verma over the impacts of parts of the agency’s “Patients Over Paperwork” initiative in the 2019 Medicare physician payment rule.  

Specifically, the proposals would reform the documentation requirements associated with physician Evaluation and Management (E/M) services and potentially reduce associated red tape. AMGA urged CMS to finalize part of the proposal that takes aim at documentation requirements in its most recent comments.

However, the association voiced its concern with CMS’s proposal to combine office and outpatient codes, AMGA wrote in comments to the agency.

“Pairing paperwork reforms with a significant change in categorizing patient complexity and reimbursement may very likely undermine care quality and coordination and cause disruption in physician workflow and referral patterns,” AMGA President and CEO Jerry Penso, MD, MBA, said in a statement.

Similarly, the American Medical Association also has concerns over the changes to E/M services, with the association arguing the proposed rule would leave the sickest patients and the physicians who treat them to encounter “significant obstacles to care.”

“This provision in the proposed rule should be filed under the category of unintended consequence—or good intentions that go awry,” Barbara L. McAneny, MD, president of the AMA, said in a statement. “While CMS started out with the laudable goal of reducing paperwork and allowing physicians to spend more time with their patients, the cascading impact of such regulations would be bad for patients and physicians.” 

AMGA is also opposed to high Merit-based Incentive Payment System exclusive thresholds that were included in the proposed rule, which was announced in July.

While some of the changes have been met with criticism, others have been supported, including the focus on simplification for physicians when it comes to documentation. See AMA’s full comments here

CMS received more than 15,000 comments from industry stakeholders over the proposals. A group of 90 lawmakers also wrote to CMS about their concerns with the code changes. 

"We are concerned that the proposal to consolidate these services devalues the expertise, clinical decision-making, and time of physicians who treat patients with complex conditions," Congressional members wrote.