Cardiologists oppose 2 key CMS proposals, warn of ‘unintended consequences’

The American College of Cardiology (ACC) has sent a 50-page letter to CMS highlighting its thoughts, concerns and recommendations related to the proposed 2022 Medicare Physician Fee Schedule (MPFS).

In a statement on its website, the group highlighted that it is recommending against “two broad proposals that would have unintended consequences.”

Those proposals are:

Billing changes for split or shared visits

The ACC opened the letter by urging CMS not to finalize its proposed policy update for split or shared patient visits.

CMS wants to define a split or shared visit as “an E/M visit in the facility setting that is performed in part by both a physician and a nonphysician practitioner who are in the same group,” for instance, and it wants to update the way providers measure whether or not they spent a “substantive portion” of any split or shared visit treating the patient in question. However, the ACC explained, changing these definitions is a more complex than CMS may realize.

Also, the group added, only allowing the clinicians who spends “a substantive portion” of a split or shared visit to bill for that visit “would be incorrect.”

“As an analogy, it would not make sense to suggest an airline pilot should not be paid for her work with the critical portions of communicating with the tower, taking off, navigating a route, landing, and steering to the gate because she also relied on autopilot for more than half of the flight time in the air and shared responsibilities with the copilot,” according to the letter. “Ultimately, this proposal serves to reduce the concept of "team-based care" by forcing clinicians to separate their time with patients. This proposal goes against the ACC's core principle of having all members of the cardiovascular team working together for the patient.”

The ACC is recommending against implementation of this new policy on split or shared visits until medical societies can spend more time reviewing their options and a more efficient strategy can be developed.

Clinical labor pricing

The ACC also recommended against the CMS proposal to increase practice expense costs for clinical staff labor in 2022. The last update was back in 2002, the group emphasized, and making such a significant change all at once could cause practice expenses to skyrocket. Budget neutrality constraints make the sudden change even more impactful, and “the burden of the offset” would be felt the most by “services performed in the nonfacility office setting for services with high supply and equipment costs.”

“If the CMS proposal goes into effect, as written, many of these nonfacility offices will fail,” according to the letter. “This will limit access to care for Medicare patients and force those patients into the facility-based system at a significantly higher cost to Medicare and to patients.”

For now, the ACC asked CMS to spend more time exploring its options related to adjusting the scaling factor. The group also pushed for policymakers to keep budget neutrality constraints when attempting to make such large updates all at once.

“CMS should analyze the effects of implementing the clinical labor rates as they have proposed, after no change for 20 years, versus having implemented those updates more regularly,” according to the letter. “CMS should publish how the annual $20 million restriction on changes to expenditures could have played a role in the clinical labor updates. CMS should also consider all the ways budget neutrality can be accounted for in the practice expense methodology, as there are several steps in the formula where budget neutrality is applied.”

The subject was also discussed at length in a previous communication with CMS.

Much more to consider

The ACC also provided its comments on multiple other issues, including RVU modifications, the development of new cost measures, MIPS value pathways, the potential continuation of certain COVID-19-related policy changes and more.

The comment letter is available in full on the ACC’s website.

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