Reduction in the conversion factor is required for budget neutrality; lobbying groups plan to appeal to Congress for help
The proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program rules released by CMS have a lot of changes, but the most important one is the 3.75% reduction in the conversion factor used to calculate payments to physicians.
The proposed cuts are the result of a reduction that is necessary to keep Medicare payments budget neutral. At the end of 2020, Congress passed a one-year fix that prevented the cuts due to take effect in 2021. Without additional intervention, the cuts will go into effect Jan. 1, 2022.
“We need to ensure that practices across the country are able to continue to operate and provide frontline care that improves health equity and patient access in their communities,” said George M. Abraham, MD, MPH, president, American College of Physicians, in a statement. “While CMS does not have the authority on their own to correct this, we ask them to support efforts to fix the problem through Congress. It is critically important for the administration and Congress to work together to prevent these cuts and ensure stability for patients and their physicians.”
The Medical Group Management Association said it will lobby Congress to intervene.
The other proposed changes were better received.
CMS is proposing to extend Medicare coverage of some telehealth services granted during the pandemic through the end of 2023 to help gather data to determine whether the services should be permanently covered. Some mental health care services can be provided on an audio-only basis going forward.
“ACP is glad to see that the proposed rule extends some of the services and increased flexibility for telehealth through the end of 2023,” said Abraham. “The stability of knowing those services will continue is important for the physicians who provide them. This also better allows CMS to study the services and will inform future policies on telehealth to make sure they work for patients and physicians.”
The rule would remove geographic restrictions for diagnosis, evaluation or treatment of a mental health disorder and allows a patient's home to serve as an originating site for a telehealth visit. It places some restrictions, including a requirement that the patient had an in-person visit within six months before the virtual visit.
However, ACP wants a much broader array of services to be allowed via audio-only, not just mental health treatment.
In the proposed QPP rule, ACP noted that they were glad to see the CMS is going to include a chronic care management as one of the seven MIPS Value Pathways for 2023.
“ACP had proposed a similar MVP concept to CMS, and we will be reviewing closely to see how CMS’s proposal aligns with ours. We are glad to see that the agency understands the benefit that chronic care management can provide patients and the importance of payment models that account for it,” said Abraham.
CMS said the changes should allow clinicians to see “greater returns on their investment in the program as we see higher payment adjustments as well as begin to see a more equitable distribution within our scoring system and small practices no longer bearing the greatest share of the negative payment adjustments."
The QPP rule also included provisions that would relax some of the reporting requirements for Accountable Care Organizations under the Medicare Shared Savings Program to give them more time to implement changes.
Public comments on the proposed rules are being accepted through September 13. The full proposal can be seen here.