CMS finalizes policies it says will lower drug prices, reduce burdens

AAFP and ACP are among the medical groups claiming CMS’s recent decisions regarding the final rule for the 2018 Physician Fee Schedule and a final rule with comment period for the Quality Payment Program make some improvements, but do not go far enough.

CMS said last week its rules will relieve regulatory burdens for providers and encourage innovation that increases competition, reduces prices, and enhances the relationship between patients and their doctors.

“During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients,” CMS administrator Seema Verma, MPH, said in a press release. “These rules move the agency in a new direction.”

Some specifics of the plan call for CMS to:

pay for more telehealth services and make it easier for providers to bill for these services, especially in rural areas;
add an option to help clinicians and small, rural practices join together and share the responsibility of participating in value-based payments;
update payment for biosimilars, starting in 2018;
lower the number of clinicians needed to participate in the Quality Payment Program; and
add a hardship exception to assist small practices and clinicians impacted by hurricanes Harvey, Irma, and Maria.

AAFP President Michael Munger, MD, said in a statement he was glad that that small group physicians and practices will have additional flexibility in reporting requirements for complex patients. However, he said other components of the CMS announcement are troubling.

“We’re concerned that CMS is prematurely requiring a full year of quality reporting for the 2018 performance year,” he said. “The current lack of prompt and actionable feedback from CMS hampers practices’ ability to correct inadvertent reporting mistakes. The full-year reporting period impedes practices’ ability to learn how to properly report, perform mid-year upgrades, make corrections in their reporting capacities and become more familiar with [Merit-based Incentive Payment] requirements.”

Munger added that the Academy will continue to help its members get ready for the Merit-based Incentive Payment System and the Alternative Payment Model.

In a separate statement, the ACP also lauded the improvements to the bonus program for complex patients and small practice options. It also noted improvements to the following components: Further Refinement of Care Management Services Codes; Evaluation and Management Documentation Guidelines Comment Solicitation; Extreme and Uncontrollable Circumstances; and Appropriate Use Criteria for Advanced Diagnostic Imaging Services.

“However, ACP has concerns about several of the provisions of the rule; in particular, some of the provisions are inconsistent with recently announced CMS initiatives on Patients Over Paperwork and Meaningful Measures,” Susan Thompson Hingle, MD, MACP, chair of ACP’s Board of Regents said in the statement.

She also expressed concern that the Merit-Based Incentive Payment System scoring remains “overly complex “and “lacks standardization”; the weight of the Cost Performance Category for 2018 is 10%, not 0% as proposed; the data completeness threshold for quality reporting data is 60%, not 50% as proposed; and that clinicians should still be allowed to participate in Merit-Based Incentive Payment System if they want to, even if they do not meet the low-volume threshold.

The president of the American College of Cardiology also said she was “pleased” that clinicians consult with appropriate use criteria for advanced imaging services starting in 2020.

However, Mary Norine Walsh, MD, FACC said in a statement she was also “disappointed” that CMS is incorporating cost into the 2018 performance year Merit-Based Incentive Payment System score.

All three medical groups indicated they would work with CMS to provide feedback and suggestions that would benefit its members. – by Janel Miller

Disclosures: Verma is CMS administrator, Munger is president of AAFP, Thompson Hingle is chair of ACP’s board of regents, Walsh is president of the American College of Cardiology.