CHICAGO — The American Medical Association (AMA) responded today to two sets of policies proposed by the Centers for Medicare and Medicaid Services (CMS). In its letter regarding the Medicare Payment Fee Schedule, the AMA pointed to areas of agreement and concerns, including:

• Data collection on surgical global codes. The AMA has serious concerns about the proposal to collect information on every 10-minute increment of patient care provided by physicians as part of activities before and after each surgery/procedure, which can occur in the hospital, office, or via email/telephone. This proposal goes far beyond Congress' intent and will be extremely and unnecessarily burdensome, not only to surgeons but to all physicians who deliver the more than 4,000 services subject to this massive proposal. This new set of regulations comes as physicians already are attempting to successfully comply with MACRA, the most significant payment system changes in the last 25 years.
• Patients with Mobility-Related Disabilities. CMS proposes a new code that would increase out-of-pocket costs for patients with disabilities and raises program integrity questions. The proposal would add a $44 fee for services rendered to patients with mobility-related disabilities. We strongly oppose this as it is funded by eliminating the physician payment increase that Congress provided for 2017 in the MACRA legislation.
• Expansion of Diabetes Prevention Program: We support expanded coverage of the Medicare Diabetes Prevention Program (DPP) model to Medicare patients at risk of developing type 2 diabetes. Expansion of the DPP model will help at-risk seniors and people with disabilities lower their risk factors and prevent their condition from advancing to type 2 diabetes. Earlier this year, CMS concluded that the expanded coverage would result in significant cost savings. The proposal also underscores the important role of prevention in stemming the tide of chronic disease, and we look forward to working with the Administration to advance this effort. We provided a few suggestions for CMS' proposal to strengthen this proposal.

"CMS has offered a comprehensive approach in the new proposal — and some of it hits and some of it misses. The programmatic changes for pre-diabetes are exactly right," said AMA President Andrew W. Gurman, MD. "We are concerned at their proposal to tailor regulations for the real world practice of medicine. Layering on a new regulation that requires reports based on 10-minute increments of service would burden physicians already attempting to comply with existing regulations that require them to spend too much time with record keeping and too little with patients."

As for the regulations involving CMS' Outpatient Prospective Payment System, the AMA sees some admirable reforms and a few red flags:

• Eliminating the site of service payment differential between physician offices and off-campus provider- based departments formed after 2017. This proposal might help preserve small, independent practices by eliminating the incentive for hospitals to purchase physicians practices.
• Allowing physicians to report Meaningful Use for 90 days in 2016. This is a much-needed reform of the earlier proposal requiring a full year of reporting and one that we have urged CMS to finalize as soon as possible. We also commend CMS for developing a hardship exception that allows first time Meaningful Use participants to report once in 2017 to satisfy both Meaningful Use and the Advanced Care Information performance category in MIPS.
• Removing pain measures from the Hospital Value-Based Purchasing Program (VBP). The AMA has repeatedly called for the removal of these questions, and applauds CMS' proposal. Pain management questions should not be used in a program where there is a link between scoring well in the program and higher payments to hospitals.
• Continuing long-standing policies that have created and are widening a very large gap between payments in Hospital Out Patient Departments (HOPDs) and ambulatory service centers. CMS should increase rates for ambulatory surgical centers (ASCs) to eliminate this disparity.
• CMS' proposal for further consolidation of Ambulatory Payment Classification (APC) groups. The AMA believes the proposal is based on inadequate analysis and may result in inaccurate reimbursement for physician services. The AMA recommends that CMS proceed cautiously before consolidating APC groups or moving APC codes from one group to another.

"It is encouraging that CMS seems to be listening to the concerns of physicians. Whether it is the reimbursement policies, satisfaction surveys or Meaningful Use requirements, CMS understood that these have impacts on how physicians practice medicine," Dr. Gurman said. "In the end, it is patients who benefit most when CMS listens and reacts to these concerns."