AMA responds to CMS fee schedule update

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The American Medical Association distributed the following press release on July 17…  

The American Medical Association (AMA) responded today to policies outlined last week in the Centers for Medicare and Medicaid Services (CMS) physician fee schedule proposed rule. The AMA finds a number of positive proposed changes that would improve patient care and save taxpayer dollars. 

“The annual physician fee schedule update is a chance for CMS to modify Medicare policy to ensure the best possible treatment options for patients,” said AMA President David O. Barbe, M.D. “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.”

Most notably, the AMA welcomed changes in the following areas: 

Request for Information on Regulatory Relief. The AMA applauds CMS’ invitation for public comment on ideas for regulatory, sub-regulatory, policy, practice and procedural changes to improve the health care system by reducing unnecessary burdens for clinicians, other providers, patients and their families. After extensive discussions with the Administration about regulatory relief, the AMA welcomes this positive step by CMS.   

Expansion of the Diabetes Prevention Program (DPP). The AMA commends CMS for moving forward to expand coverage of the Medicare DPP model to Medicare patients at risk of developing type 2 diabetes. This expansion will ensure at-risk seniors and people with disabilities have access to an evidence-based DPP that can help them lower their risk factors and prevent or delay the progression to type 2 diabetes. The AMA is pleased that CMS has made an effort to address AMA’s concerns that the proposed payment model was too restrictive in linking payments to patient adherence in attending sessions and health outcomes as measured by weight loss in a short period of time. The new proposal provides more flexibility to DPP providers in supporting patient engagement and attendance and by making performance-based payments available if patients meet weight-loss targets over a longer period of time. 

The expansion underscores the success of a three-year demonstration project of the YMCA of the USA, funded by Center for Medicare and Medicaid Innovation (CMMI), where the AMA partnered with local YMCAs and 26 physician practice sites in eight states to increase physician referrals of individuals with prediabetes to evidence-based DPPs at local YMCAs.

The pilot program projected an estimated savings of $1.3 billion, prompting CMS to conclude last year that the expanded coverage would result in significant cost savings. This is a groundbreaking policy decision to cover evidenced-based prevention activities that improve patient health and reduce total health expenditures. 

Consolidate and Streamline Legacy Value-Based Payment Systems. CMS listened to the AMA and physician community to make retroactive modifications in the 2016 Physician Quality Reporting System (PQRS), Meaningful Use (MU) and Value-Based Payment Modifier (VM) requirements to reflect the policies in the Merit-based Incentive Payment System (MIPS) – reducing penalties for physicians in 2018. 

Delayed Implementation of Appropriate Use Criteria. In the proposal, CMS will delay implementation of a program created under the Protecting Access to Medicare Act that would have denied payment for advanced imaging services unless the physician ordering the service had consulted appropriate use criteria. The AMA appreciates CMS’ decision to postpone the implementation of this requirement until 2019 and to make the first year an opportunity for testing and education where consultation would not be required as a condition of payment for imaging services.