A large number of medical professional organizations and state medical associations -- nearly 90 in total -- recently joined forces to ask CMS Administrator Seema Verma, M.P.H., for relief from penalties associated with programs that have been replaced with initiatives created to implement the Medicare Access and CHIP Reauthorization Act (MACRA).
Programs under the microscope are meaningful use (MU), the Physician Quality Reporting System (PQRS) and the value-based payment modifier (VM).
Specifically, in a March 21 letter(4 page PDF) to Verma, the AAFP, AMA and other groups said that any steps CMS takes to "minimize the penalties" accrued by physicians who tried to participate in these programs would be viewed favorably by those affected.
"Clearly this would send a strong message to the physician community about the extensive regulations with which physicians have been dealing and the administration's commitment to reduce the burden," said the letter.
The letter called out the 21st Century Cures Act that was signed into law on Dec. 13, 2016, and noted that as directed by language in that legislation, "CMS must establish a strategy to relieve the electronic health record documentation burden."
- The AAFP signed on to a letter with nearly 90 other organizations asking CMS for relief from penalties associated with programs enacted prior to passage of the Medicare Access and CHIP Reauthorization Act.
- Specifically, the organizations asked for a rollback in rules regulating meaningful use, the Physician Quality Reporting System and the value-based payment modifier.
- The organizations said steps outlined in the letter are consistent with CMS efforts to move forward with new programs and also align with President Donald Trump's efforts to reduce the regulatory burden imposed by the federal government.
As part of that effort, the organizations asked CMS to create a new category of hardship exemption for the 2016 MU performance year and label it "Administrative Burden."
"Eligible providers should not be penalized for focusing on providing quality patient care rather than the arbitrary 'check the box' requirements of MU," said the letter. Furthermore, establishing the new exemption "would provide immediate relief for those impacted by the programs that predate MACRA."
The groups also requested another hardship exemption category to protect physicians who tried to participate in PQRS in 2016 but failed because of the complexity of reporting requirements and the sheer volume of measures that were required.
"Therefore, we recommend that CMS create a hardship exemption that would allow physicians who successfully reported on any number of PQRS measures in 2016 to avoid the 2 percent penalty in 2018," said the letter.
The organizations agreed that, based on changes made to the Quality Payment Program(qpp.cms.gov) that eventually replaced these earlier programs, CMS evidently has recognized that physicians struggled to understand and meet the original requirements.
The organizations also urged CMS to take immediate steps to insulate physicians from additional penalties related to VM calculations that could be as steep as 4 percent.
For starters, the letter suggested that physicians who avoided the PQRS penalty in 2018 should also be excused from any penalties association with the VM.
"Physicians who met the nine-measure PQRS submission requirements or were eligible for a PQRS hardship exemption would not be penalized under the VM unless they voluntarily chose to compete and then scored poorly in the tiering process," said the letter.
Furthermore, any payment adjustments should be budget-neutral, with bonuses for high performers coming from the penalties paid by physicians who didn't participate in PQRS or who performed poorly in the tiering process.
Finally, "Practices of all sizes would receive a performance feedback report so that they could gain a better understanding of Medicare cost and quality measures and identify areas where their performance could be improved," said the letter.
The organizations noted an apparent awareness among members of Congress and the Trump administration that "fair and accurate measurement of physicians' performance" relies on having better tools to facilitate that measurement.
The groups also expressed appreciation for CMS' efforts to "recognize and compensate for methodological shortcomings in MU, PQRS and VM."
Steps outlined in the letter are "consistent" with CMS efforts to move forward with new programs and also align with President Trump's efforts to reduce the regulatory burden imposed by the federal government, stated the groups.
In closing, the organizations offered continuing cooperation. "We recognize that there might be others ways to achieve the same goal. We are open to discussing other options."