2012 MPFS Final Rule — Alliance of Specialty Medicine Letter
On November 1, 2011, the Centers for Medicare and Medicaid Services (CMS) released the 2012 Medicare Physician Fee Schedule (MPFS) final rule, which addresses changes to the physician fee schedule and other Medicare Part B payment policies. This final rule outlines payment policies for the Physician Quality Reporting System (PQRS), the Electronic Prescribing (eRx) Incentive Program, the Physician Resource and Use Feedback Program and the value modifier. Learn more about the final rule »
On January 3, 2012, the Heart Rhythm Society along with members of the Alliance of Specialty Medicine sent a letter to CMS commenting on:
Read the full letter (PDF, 158K) »
Lack of Transparency in the Refinement Panel Process
For many years CMS has utilized refinement panels to respond to public comments about the relative values assigned to individual CPT codes. Requestors could provide their rationale as to why a code is misvalued and the refinement panel would review the information to determine if CMS should change its decision. In the Final Rule, CMS indicated that it was not going to rely on the outcomes of the September 2011 refinement panel’s decisions and that instead the Agency intends to establish a new approach to refining codes. There is significant concern about the composition, process and transparency of the new refinement panel approach.
While Alliance members were pleased when CMS announced that it would make the refinement process more transparent, the Alliance asserts that CMS did not fulfill its promise to make improvements to the refinement process and now intends to limit access to the future process. The Alliance is concerned about CMS's refusal to accept the refinement recommendations for codes for which the Agency says it has an established policy. If refinement panel recommendations are uniformly overturned on the basis of pre-existing CMS policy, there is no utility in the panels for CMS or physicians.
The Alliance urges CMS to revisit this position, to carefully assess refinement panel recommendations for all codes for which specialty societies request re-review and to accept the values recommended by the objective refinement panels.
In the final rule, CMS also states that it will require new data, not presented at the Relative Value Scale Update Committee (RUC), to consider codes for the refinement process in the future. While the Alliance agrees that physician societies should be permitted to submit additional data when available, it does not agree with limiting the opportunity for refinement to those specialties that have information not presented at the RUC. In many instances, there is no additional information to provide to a refinement panel because all available data has been presented to the RUC.
CMS Policy on Valuing Surgical Procedures With 23-hour Stays
The Alliance supports the AMA RUC policy of recognizing the time the physician spends in the hospital care for a surgical patient. The content of the care does not vary with the outpatient or inpatient designation by the hospital. The same evaluation and management services are provided to these patients regardless of “observation” status. CMS disagreed with the RUC recommended values for many surgical codes and rejected refinement panel recommendations for higher values because the Agency believes “that it is reasonable to expect that there have been changes in medical practice for these services, and that such changes would represent a decrease in physician time or intensity or both.”
The Alliance asserts that CMS should value care provided to patients on observation status regardless of the type of physician providing the patient care.
Value-Based Modifier
In December 2011, CMS staff indicated that they are working on an attribution method whereby care from physicians is differentiated into “directed care,” “influenced care,” and “contributed care.” The specifics of this attribution methodology have not yet been defined. Since the attribution methodology is one of the fundamental foundations of the value-based program, the Alliance urges CMS to actively seek input from stakeholders by holding multiple public meetings prior to the 2013 rulemaking cycle and to test the methodology before implementing it to ensure that it can account for most of the total Part A and B costs and covers most individual physicians.
