Comments on 2011 MPFS

The Heart Rhythm Society, joining the other members of the Alliance of Specialty Medicine, sent a letter to Donald Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services (CMS) expressing concerns over payment policies changes made in the 2011 Medicare Physician Fee Schedule Final Rule. View the Alliance Letter » (PDF, 176K)

The Alliance's primary concern focuses on the increased rate of rejection by CMS of the recommended work values by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC).

The Alliance believes that the AMA RUC recommended physician work values typically represent the most thoroughly vetted estimates for the value of physician work available at this time. The RUC provides a deliberative process for evaluating physician work, which uses standard physician work estimation surveys to develop physician work RVU recommendations, ensuring relativity within the Resource-Based Relative Value Scale (RBRVS). Therefore, the Alliance is concerned that CMS has accepted only 71 percent of AMA RUC Recommendations for 2011, instead of 90 percent normally.

While the recently passed health care reform law directs the Secretary of the U.S. Department of Health and Human Services (HHS) to establish a process to validate RVUs within the Physician Fee Schedule in the Final Rule, CMS does not describe in the final rule any new policies or approaches it employed to validate RVUs.In most instances, CMS has not provided any substantive evidence for rejecting the RUC recommendations nor has it provided substantive evidence in support of the alternative values assigned by CMS.

The Alliance has serious concerns with the CMS decision to implement the initial round of e-prescribing penalties on claims-based reporting during the first six months of 2011. The “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA) (P.L. 110-275), which created the e-prescribing program, supports delaying penalties against physicians who do not e-prescribe to 2012. Despite the opportunity for delay, CMS is requiring in regulation that an eligible physician report the e-prescribing G-code at least ten times for applicable Medicare office visits and services for the January 1, 2011 through June 30, 2011 reporting period in order to avoid penalties in 2012.

The Alliance believes that financial penalties should only be levied in 2012 and 2013 for Medicare-eligible physicians who fail to meet the e-prescribing reporting requirements or do not qualify for an exemption by the end of 2012 or by the end of 2013.

The Alliance also expressed concern that CMS only permitted claims-based reporting for the e-prescribing program and did not offer any options for physicians to use a qualified registry or EHR to report e-prescribing activity.

In response to its concerns, The Alliance asks CMS to:

Extend the reporting period for the e-prescribing program so that 2012 and 2013 penalties are based on reporting during those years and not on activities in 2011

Develop an exception to the e-prescribing penalties in 2012 for eligible providers who earn the Medicare EHR incentive in 2011 or 2012

Provide regular feedback reports on physician participation in the e-prescribing program and create a standardized appeals process for physicians that want to appeal determinations related to eligibility and incentive qualification