AAFP Takes Credit for Progress Made in CMS' Proposed Rule

FPs Would Benefit on Two Fronts

July 13, 2016 03:30 pm News Staff

After repeated legislative and advocacy efforts by the AAFP, CMS finally heeded the call to implement a 90-day reporting period in 2016 for physicians participating in the Medicare Electronic Health Record (EHR) Incentive Program.

[Gears spinning with the word

The language on meaningful use reporting was slipped into CMS' recently released proposed rule(www.federalregister.gov) on changes to the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System for 2017.

The proposed rule also benefits family physicians by providing an implementation plan for site-neutral Medicare payment, an issue that Congress addressed in the Bipartisan Budget Act of 2015 and that the AAFP ultimately checked off as a legislative win.

According to CMS' July 7 press release,(www.cms.gov) the proposed site-neutral changes would put the payment focus on patients rather than the setting in which care was provided.

"The items in this proposal are designed to improve care and value when Medicare beneficiaries receive care in an outpatient setting," said CMS Acting Administrator Andy Slavitt. He added that the proposed updates would help physicians provide patients "the right care at the right time."

Story Highlights
  • The AAFP credits its advocacy and legislative efforts in prompting CMS to make changes in a proposed rule that will benefit family physicians.
  • CMS proposed the implementation of a 90-day reporting period in 2016 for participants in the Medicare Electronic Health Record Incentive Program.
  • The proposed rule also provides an implementation plan for site-neutral Medicare payment -- an issue that Congress addressed in the Bipartisan Budget Act of 2015.

Applying Site-neutral Payment Policies

CMS noted in the press release that Medicare currently pays a higher rate for certain services provided in an off-campus hospital outpatient department than it does for the same services provided in a physician's office.

The payment differential encourages hospitals to "acquire physician offices in order to receive the higher rates" and has led to increased costs to the Medicare program, said CMS.

The proposed rule could reduce outpatient spending by some $500 million, noted the agency.

Importantly, on more than one occasion, the AAFP pointed out that CMS was squandering financial resources by pursuing this inequitable payment system.

For instance, back in August 2013,(21 page PDF) the AAFP urged CMS to stop paying more for services provided in outpatient or ambulatory surgical settings than in physician offices and encouraged CMS to "create incentives for services to be performed in the least costly location -- such as a physician's office."

The Academy used the same rationale in a 2014 letter to CMS:(16 page PDF) "The AAFP continues to advocate for bringing more equity in payment across sites of service."

Adjusting 2016 Meaningful Use Reporting Period

Regarding changes to the reporting period for the Medicare EHR Incentive Program, CMS noted in its press release that it intended to support physicians and other health care professionals by "increasing flexibility for hospitals and critical-access hospitals" that participate in the program.

In the proposed rule, CMS suggests implementation of a 90-day EHR reporting period in 2016 -- a change that effectively would replace the full-calendar-year reporting requirement for returning participants.

The change is one that the AAFP has called for on several occasions.

For instance, in an April 11, 2016, letter(8 page PDF) to CMS regarding AAFP input on the Medicare Access and CHIP Reauthorization Act, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., specifically urged CMS to "allow participants to report on any 90-day period in 2016, as was the policy in 2015 and in each prior program year."

A similar request was made in a March 15, 2016, letter(2 page PDF) signed by the AAFP and more than 30 other medical organizations.

Those organizations told CMS that reducing the reporting period would "continue the significant progress" physicians had made in harnessing technology to ensure their success in new payment and delivery models.

And in a May 26, 2015, response(5 page PDF) to CMS' proposal on certified health information technology, the Academy opposed the agency's plan to change course midstream by removing the 90-day EHR reporting period for physicians, hospitals and critical-access hospitals that were "attempting to demonstrate meaningful use for the first time."

The AAFP argued at that time that requiring a full-calendar-year reporting period would place an "enormous burden on all new adopters of EHRs" and would also stifle those physicians "struggling to modernize their practices and meaningfully use an EHR."

Furthermore, the Academy expressed concern that implementation of a full-year reporting requirement would negatively affect practices that had an opportunity to update to new certified EHR technology. Those practices would be bound by CMS' full-year reporting rule and, thus, be chained to inadequate technology and subjected to another year of penalties, argued the AAFP.

The AAFP will comment on the proposed rule by the Sept. 6 deadline and looks forward to seeing those proposals that benefit family physicians survive the regulatory process intact.

However, Academy sources cautioned that the site-neutral payment proposal likely would draw opposition from organizations whose members face negative impacts from the change.

Related AAFP News Coverage
Medicare Access and CHIP Reauthorization Act
AAFP Seizes Momentum, Articulates MACRA Vision for Family Medicine


AAFP Argues for Extended 90-day MU Reporting Period

Meaningful Use Stage Three
AAFP Demands Physician-Friendly MU Rules


AAFP Works to Fine-tune 2015 Proposed Medicare Physician Fee Schedule

Additional Resource
CMS Fact Sheet: CMS Proposes Hospital Outpatient Prospective Payment Changes for 2017(www.cms.gov)