The American College of Rheumatology Responds to CMS' Proposed Rule

The American College of Rheumatology (ACR) has issued a response to CMS’ 2018 Physician Fee Schedule (PFS) proposed rule, which was issued earlier this month.

The ACR, a professional membership organization that advocates for more than 9500 members that include rheumatology care providers and researchers, praised CMS for seeking stakeholder input on the ways in which the body can achieve transparency, flexibility, program simplification, and innovation with respect to its policies, including policies affecting payment for biosimilar products. ACR says that making improvements to Medicare will be essential to ensuring that rheumatology practices, especially practices that serve rural areas, can continue to provide quality care to patients.

The ACR voiced its support for a revision to the value modifier (VM), an adjustment made on a per-claim basis to Medicare payments for items and services based upon physicians’ performance on quality and cost criteria. The proposed rule would reduce the VM adjustment:

• From -4% to -2% for practices of 10 or more clinicians who do not meet CMS’ reporting requirements
• From -2% to -1% for physicians practicing alone or in groups of up to 9 clinicians.

However, ACR calls on CMS to go further in easing the VM burden on practitioners by establishing a VM adjustment of 0% in 2018.

ACR also praised CMS for delaying the implementation of appropriate use criteria (AUC) for advanced diagnostic imaging services. AUC, introduced in the 2016 PFS Final Rule, are evidence-based criteria that CMS says will “assist professionals who order and furnish applicable imaging services to make the most appropriate treatment decisions for a specific clinical condition” once they are implemented. The ACR says that it supports a gradual phase-in of AUC, and that it supports exemptions to the program for physicians practicing in underserved areas.

ACR also called on CMS to address what it sees as shortcomings to the proposed rule:

• Quality feedback reports. ACR affirmed its belief that the process for receiving real-time feedback should be streamlined and simplified, and proposed that CMS offer user-friendly, quarterly Quality and Resource Use Reports along with 90 days for appeal.
• Practice expense reimbursement cuts for injections. ACR indicated that cuts to reimbursement for injections could reduce patient access to key services.
• Evaluation and management billing codes. Emphasizing the failure of existing codes in reflecting the full range and complexity of the services that rheumatologists provide, ACR said that it hopes to see payment based on services provided rather than specialty designation.
• J-codes for biosimilar products. ACR voiced its support for the assignment of a unique J-code to each biosimilar product for better tracking and pharmacovigilance. CMS is considering revising its current billing code policy, which groups payment for all biosimilar products referencing a single originator biologic by the same Healthcare Common Procedure Coding System (HCPCS) code. CMS reports in its proposed rule that it has received extensive feedback that the current policy could negatively impact not only pharmacovigilance practices but also price competition among biosimilars and biologics.

ACR reports that its full response to the proposed rule will be made during the public comment period. CMS is receiving comments on the proposed rule through September 11, 2017.