CMS wanted comments. It got close to 29,000, including a flood from physical therapists and psychologists.
As the comment period comes to a close tomorrow on a proposed physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) already got an earful, including letters from physical therapists, psychologists and social workers telling the agency not to cut their Medicare reimbursements.
As of this morning, the federal agency received close to 29,000 comments on the proposed regulation that makes changes to the physician fee schedule and updates the Quality Payment Program established under MACRA. The comment period closes at 5 p.m. Friday.
Hundreds of comments came from physical therapists, psychologists and social workers who appealed to CMS not to cut their reimbursements so higher payments can be made for evaluation and management (E/M) services included in the proposed rule (PDF).
There were several controversial issues in the proposed rule issued in late July to establish 2020 Medicare payment rates and make changes to the physician payment program implemented under MACRA, including the Merit-based Incentive Payment System (MIPS).
CMS is now expected to review the comments and will issue a final rule this fall.
In general, physician groups were happy the government pulled back on once-controversial changes to E/M services.
But hundreds of physical therapists, psychologists, and social workers told CMS it should not balance those changes on their backs. They wrote in opposition to:
- A proposed 8% cut to physical therapy services. “This proposed cut is the latest in a history of cuts to physical therapy services over the past decade,” said one commenter. “Margins for physical therapists are already so low that many providers, particularly in rural and underserved areas, will likely be forced to close if this additional cut is implemented in 2021.” If CMS wants to decrease the use of opioid painkillers, it should be expanding access to physical therapy, not cutting it, the commenter said.
- A reduction in reimbursement for psychologists and social workers that will cut payments by 7% in 2021. “I am a psychologist practicing in Wisconsin, and I am one of a few providers qualified to meet with patients with Medicare in my area. There are already a limited number of providers, and by reducing reimbursement it will further impact access to care to a growing population with mental health needs,” wrote Kathryn Keller, Ph.D.
However, groups such as the Medical Group Management Association (MGMA) and the AMGA praised CMS’ changes to the E/M codes.
"CMS was right to heed MGMA's recommendation to walk back the collapsing of E/M payment rates, which was strongly denounced by the physician community,” said Anders Gilberg, senior vice president, government affairs at MGMA, in the organization's comment letter.
In a CMS fact sheet on the proposed changes, the agency said it would align E/M coding changes with those laid out by a panel set up to study the issue.
CMS proposes to retain five levels of coding for established patients, reduce the number of levels to four for office/outpatient visits for new patients and revise the code definitions. It will allow clinicians to choose the E/M visit level based on either medical decision-making or time.
MGMA was also happy to see the agency’s high-level proposal to streamline MIPS, which Gilberg called a step in the right direction, but urged CMS to engage the stakeholder community as it builds out the policy framework.
“For the agency to successfully reduce regulatory burden, physician practices must have a seat at the table,” he said.
The AMGA also voiced support in its letter (PDF) for CMS’ decision to pay separate rates for office and outpatient E/M codes. “CMS recognized that its earlier plan for E/M visits would have disrupted care patterns and may have created other unintended consequences,” said Jerry Penso, M.D., AMGA president and CEO. “Having separate codes helps acknowledge the difference in resources in treating patients with more complex care needs.”
The organization also offered assistance to work with CMS to develop a reformed reporting system for MIPS. The proposed rule includes a new framework for MIPS called MIPS Value Pathways with the goal of making it easier for physicians to participate in the program.
Another issue, which drew comments both pro and con, was a proposal to allow certified registered nurse anesthetists (CRNAs) to provide the pre-anesthetic assessment in ambulatory surgical centers (ASCs) as part of the Conditions for Coverage.
“CRNAs are highly educated anesthesia experts who are fully qualified to provide the pre-anesthesia assessment,” wrote Katherine Morse, of Rye, New Hampshire.
Others disagreed. “Removing the anesthesiologist from the evaluation of patients before anesthesia puts our patients at risk. Anesthesia care at an ASC is nuanced and nothing can replace physician-led care,” wrote another commenter.