Doc Group Blasts CMS Physician Fee Schedule Plans

MGMA-ACMPE has penned a blistering 18-page report in response to the proposed federal rule on payments to doctors, criticizing the Centers for Medicare & Medicaid Services for inaccuracy, inconsistency, and being misleading.

Big and bureaucratic, the Centers for Medicare & Medicaid Services has the last word on day-to-day healthcare policy and on physician payments. What CMS says, goes in or out of the physician paycheck.

As part of its policy-making process, CMS has closed the books on comments for its proposed rule for the 2014 Physician Fee Schedule. The CMS plan cites proposed quality measures for docs, and structures of some payment. On some level, it's part of the regulatory morass. But it carries the potential for explosive repercussions. And at least one physician organization is saying 'enough already.'

MGMA-ACMPE has penned a blistering 18-page report in response to the CMS proposed rule, criticizing the massive agency for inaccuracy, inconsistency, being burdensome, complicated, and yes, misleading.

I get the sense MGMA-ACMPE is a little fed up. "We have made a lot of these arguments, over and over," Allison Brennan, MPP, a Washington D.C.-based senior advocacy advisor for MGMA, told me. "If it seems a little tough, [it is because] we have voiced these opinions repeatedly and we continue to emphasize the importance of CMS to address these fundamental problems."

The barrage of MGMA-ACMPE complaints extends to billings, data collection, and the gathering of quality measures. Among the concerns are problems with the Physician Quality Reporting System, which is supposed to use a combination of incentive payments and payment adjustments, to report quality; and the consumer doctor rating system, Physician Compare.

Flaws in those plans and other areas of CMS policy-making are unsettling to MGMA-ACMPE and other physician groups. Among the problems, says Brennan, is that CMS is moving toward revamped regulations, even though there aren't assurances that current programs will be regulated properly.

For physicians, "there are a lot of administrative burdens, so the CMS regulations are a considerable drain on the time and resources on medical practices," Brennan says.

MGMA-ACMPE includes 22,500 members who manage and lead 13,200 organizations. Its 280,000 physician members provide more than 40% of the healthcare services delivered in the U.S, the group says. Its constituency, obviously, represents only a certain group of the estimated 1 million physicians in this country, many of whom who are represented by dozens of other organizations. But the group's outrage reflects concerns by other groups, who also have their struggles with CMS.

One such group is the American Association of Medical Colleges, which includes 141 accredited medical schools, and nearly 400 major teaching hospitals and health systems.

Similarly, the AAMC has concerns over lack of standards, puzzling and confusing data questions, and contradictory elements of planning in the CMS proposals, Mary Patton Wheatley, MS, director of health care affairs for AAMC, tells me.

In its response to the physician fee schedule plan, AAMC noted that 6% of a practice's 2016 Medicaid payments are "at risk" based on reporting and performance in 2014. By having unclear objectives and standards, Wheatley says CMS is hindering physicians' chances to meet expectations. "It is essential that the Medicare program move ahead at a reasonable pace and with clear rules that are well understood," AAMC wrote to CMS administrator Marilyn Tavenner.

Yet, CMS is preparing complex changes before ensuring accuracy of existing systems, Wheatley says.

The MGMA-ACMPE and AAMC were among the dozens of physician groups who filed comments on CMS's proposed rule to revise payment policies under the physician fee schedule, for 2014. Physician groups expect CMS to issue the rules sometime in November. Whether their comments have any clout, physician groups believe they can only guess.

"I think the challenge for CMS is that they are trying to build a policy that adapts to a wide variety of specialties; multi-specialty centers, urban centers, and remote locations. And they are trying to have a single practice policy," says Wheatley. "That's why physician policies are so difficult to put together, because of the variety of physician practices, and a lot of variability."

Regardless of their constituencies, MGMA-ACMPE and AAMC are unanimous in their criticism of the CMS website used to evaluate doctors and their practices. Both groups have reported that many physicians and practices have expressed concerns about inaccurate information on Physician Compare, which they say is difficult to correct and confuses beneficiaries.

When a physician identifies inaccurate information on Physician Compare, it often takes months to be corrected, Brennan of MGMA-ACMPE says.

"We're not opposed to Medicare or CMS putting this information out there," says Brennan. "But when it's not done properly, it ends up creating more negative repercussions. Without ensuring accuracy of the information, Physician Compare is missing the mark."

In a statement to CMS, AAMC also expressed similar concerns about Physician Compare, saying it is "concerned about the validity across the different reporting mechanisms. "Finally, even with the all progress CMS has made on the Physician Compare website, group practices are still finding errors about physicians and their affiliated practices."

Neither organization has detailed exactly how many "inaccuracies" there are in Physician Compare. To improve the program, CMS has made some changes to Physician Compare, such as tweaks to a website redesign, and beefed up its information. Still, the agency's efforts have been too feeble, says Brennan, noting that it needs to conduct a "thorough analysis of the accuracy of information" on Physician Compare.

Another major problem in the fee schedule involves the Physician Quality Reporting System, which provides incentive payments to physicians.

CMS is proposing to increase significantly the required number of measures, from three to nine, that the federal agency would use to allow physicians to earn an incentive, and avoid penalties under the Physician Quality Reporting System.

Physicians groups say it's going to be tough for doctors to identify relevant measures to report their processes successfully. Many physicians and practices do not "have sufficient experience with the program to justify such a dramatic increase in the number of measures required, particularly to avoid a penalty," according to MGMA-ACMPE.

"We have significant concerns that CMS wants to increase the measures, and it essentially requires tripling the workload," Brennan says. "It's increasingly frustrating for members in the program.

It's one thing to jump hoops to earn bonus points, and then another to have to jump through hoops to avoid being penalized. That's a different story." MGMA urges CMS to finalize "more achievable criteria" for both earning a 2014 PQRS incentive and avoiding a 2016 penalty.

Indeed, CMS is moving forward before it can "ensure the accuracy and stability of the performance scoring of the cost and quality measures," the AAMC stated, adding its concerns about the proposals for the Physician Quality Reporting System.

While CMS is reviewing data and collecting information from physicians, CMS has shown no indication that it has the time to properly evaluate what it receives before it seeks new measures. Physicians have trouble keeping pace. "There is no time to make improvements, or do anything else," says Wheatley of AAMC. Once the information is collected, there are many questions wrapped around it, like, "what are the details behind it?"

Whether CMS acknowledges the physician complaints remains to be seen. Overall, however, Wheatley says, [CMS] has a very good record of trying to seek feedback."

Feedback is one thing, she acknowledges. Whatever final changes CMS makes will be the key toward potential outcomes for physician payments in 2014. "We aren't there yet," Wheatley says.