ACS Advocacy Brief: September 19, 2024

ACS Comments on Proposed Medicare Payment Rules for 2025

In July, the Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2025 proposed rules for the Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), and Ambulatory Surgical Center (ASC) Payment System. These proposed rules contained several provisions of interest to surgeons, and, in early September, the ACS responded to CMS with detailed comment letters.

MPFS Proposed Rule 

Global Codes Policies

In its letter, the ACS strongly opposed the implementation of CMS proposed global codes policies, which would expand the use of transfer of care modifiers and implement a new add-on code in instances where CMS believes a non-surgeon provides postoperative care. The College emphasized that these policies will not result in any meaningful information about the care that surgeons are providing in the postoperative portion of the global period, and therefore, will not generate accurate, complete, and actionable data for improving the accuracy of global code values.

Primary Care Management

The ACS also expressed concern with CMS’s proposed adoption of three new billing codes that would provide capitated per-member, per-month payments to primary care practitioners for managing the care of patients with chronic conditions. The College noted that these “advanced primary care management” codes are not evidence-based and may result in unnecessary out-of-pocket costs for patients without producing improvements in care.

Further, the ACS highlighted that while complexity of care is the equivalent across all disciplines of medicine, CMS continues establishing new—and often duplicative—codes for certain specialties (e.g., primary care) to pay for various care management services, but does not apply this same logic for proceduralists.

The College strongly disapproved of CMS’s failure to similarly pay surgeons for the extra intraoperative and postoperative complexity, intensity, and work related to the same patients before, during, and after an operation.

Quality Payment Program (QPP)

The College commented on several issues related to the QPP.

The ACS responded to a request for information (RFI) on the use of the Merit-Based Incentive Payment System (MIPS) Value Pathway (MVP) framework in a potential value-based payment model for improving ambulatory specialty care. The College expressed its strong opposition to repurposing the MVP framework in ambulatory settings, stating that using MVPs will show little variations in ambulatory surgery center (ASC) care. Instead, the ACS urged CMS to use condition- or procedure-specific measures that focus on patient goal attainment and patient experience.

Likewise, the College opposed the implementation of a new Surgical Care MVP, stating that MVPs do not create value for patients for the price of care or drive teams that improve. The ACS urged CMS to focus on developing "programmatic measures," such as the Age Friendly Hospital measure, which identify clinical frameworks based on evidence-based best practices to provide goal-centered, clinically effective care for patients.

The College also supported multiple proposals to reduce the burden on QPP participants. The proposals and the ACS’s responses are detailed below. 

• Proposal to modify the scoring methodology for the cost performance category beginning with the CY 2024 performance period to ensure that clinicians with costs near the measure's median do not receive a disproportionately low score. The ACS encouraged the CMS to apply this new policy for the 2024 performance period but also previous performance years.
• Proposal to maintain the performance threshold at 75 points for the 2025 performance period. The ACS supported this proposal and noted that if the performance threshold is increased, surgeons could potentially be disincentivized from participating in Medicare

OPPS/ASC Proposed Rule

In its letter, the ACS supported CMS’s proposals for updating and expanding coverage for colorectal cancer screening, along with its proposals to decrease prior authorization review timeframes for services furnished in hospital outpatient departments.

The College also urged the addition of several measures to the Hospital Outpatient Quality Reporting and ASC Quality Reporting programs. The ACS expressed its support for the addition of the Hospital Commitment to Health Equity and the Social Drivers of Health (SDOH) measures in the outpatient programs.

In addition, the College proposed modifications to the Screen Positive Rate for the SDOH measure, noting that the measure should include the actions taken following a positive screen.

Finally, the ACS urged the use of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Outcome-Based Performance Measures (PRO-PMs) across several CMS programs. The College emphasized that PROMs and PRO-PMs can add significant value to the patient by focusing care on what matters to them.

Contact regulatory@facs.org for more information.

ACS Leads Surgery and Anesthesia Coalition Statement on Addressing Medicare Payment

The ACS led a statement signed by more than 20 organizations representing surgeons and anesthesiologists on the challenges facing surgical care and urged Congress to ensure a stable Medicare physician payment policy.

Surgeons and anesthesiologists are expecting another 2.8% payment cut because temporary congressional relief is set to expire at the end of the year. Previously, relief was provided to mitigate reductions resulting from long-term problems with the statutory budget neutrality requirement and its impact on the Medicare conversion factor.

The ACS strongly opposes these planned CMS cuts, which will reduce payments for surgical care, taking effect in January 2025. Since 2001, physicians have seen their Medicare payments decrease by nearly 30% after adjusting for inflation.

The statement also urges Congress to establish an annual update to the Medicare Physician Fee Schedule based on the Medicare Economic Index starting with CY 2025, which is comparable to updates in other payment programs (such as hospitals). This important adjustment will address the currently anticipated cut and help ensure that payments keep pace with medical cost inflation.

In this statement, the ACS provides several long-term solutions that would greatly improve the flawed physician payment system. The College will continue to work with Congress on bringing stability to Medicare payment and reforming the broken system. 

Read the full statement.

ACS Joins Expansive Coalition Letter to Congressional Leadership

The ACS recently signed a letter urging Congressional leadership to address the pending 2.8% cut to Medicare physician payments by providing an inflationary update in 2025 and beyond.

This letter, signed by more than 120 organizations representing more than one million clinicians and the patients that they serve, discussed the importance of an inflationary update and the need for clinicians to have financial stability to protect beneficiary access to high-quality care.

Read the full letter.

Urge Your Representative to Add Their Name to Medicare Payment Congressional Sign-On Letter

The ACS is strongly supporting a congressional sign-on letter being circulated by Representatives Mariannette Miller-Meeks, MD (R-IA), Jimmy Panetta (D-CA), Greg Murphy, MD (R-NC), Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), Kim Schrier (D-WA), John Joyce, MD (R-PA), and Ami Bera, MD (D-CA). The letter—addressed to House leadership—urges swift action stopping the full 2.8% cut to Medicare physician payment by providing an inflationary update equivalent to the Medicare Economic Index.

Medicare payment rates have fallen 29%over the last 2 decades when adjusting for the costs of running a practice, and the CY 2025 MPFS Proposed Rule highlights that practice costs such as rent, staff salaries, and supplies are expected to rise significantly next year.

Visit SurgeonsVoice and write to your Representative today, telling them to cosign the letter that will help protect surgical practices and Medicare patients.

Register Now for 2024 MIPS Value Pathways 

MIPS participants can now register for MIPS MVPs for the 2024 performance year. Individuals, groups, subgroups, and Alternative Payment Model (APM) Entities can register to report an MVP through December 2, 2024, at 8:00 pm ET.

MVPs are the newest reporting option for MIPS-eligible clinicians. Each MVP contains a subset of measures and activities related to a specialty or condition. In the 2024 performance year, there are 16 reportable MVPs. Surgeons should visit CMS’s Explore MVPs page to review the available MVPs and determine if any apply to their practice. Should you decide to participate, you should first identify the information listed on the Learn about MVP Registration site.  

The registration process in 2024 differs from previous years. While MVP participants in 2023 submitted an Excel form to the QPP Service Center, registrants in 2024 must: 

• Sign in to the QPP website with their Health Care Quality Information System (HCQIS) Access Roles and Profiles (HARP) account
• Click Register or edit an MVP registration from the landing page
• Click your MVP reporting option

For more information, visit the QPP Resource Library or contact QualityDC@facs.org.

Applications Open for 2024 QPP Exceptions

Applications for QPP Exceptions are now open through December 31, 2024, at 8:00 pm ET. CMS offers multiple QPP exceptions for which MIPS-eligible clinicians can apply, such as the MIPS Promoting Interoperability (PI) Performance Category Hardship Exception and MIPS Extreme and Uncontrollable Circumstances (EUC) Exception.

MIPS PI Performance Category Hardship Exception

The MIPS PI Performance Category Hardship Exception allows individual clinicians, groups, and virtual groups to have their MIPS PI Performance Category reweighted to 0% if they meet any of the following criteria:

• Have decertified Electronic Health Record (EHR) technology
• Have insufficient internet connectivity
• Face extreme and uncontrollable circumstances such as a disaster, practice closure, severe financial distress, or vendor issues
• Lack control over the availability of certified EHR technology

MIPS EUC Exception

The MIPS EUC Exception Application allows individual clinicians, groups, and virtual groups to have one or more of their MIPS performance categories reweighted to 0% if they have experienced rare events entirely outside their control and the control of the facility in which they practice. These circumstances must:

• Cause them to be not collect information necessary to submit for a MIPS performance category
• Cause them to be not submit information that would be used to score a MIPS performance category for an extended period
• Impact their normal processes, affecting your performance on cost measures and other administrative claims measures

Surgeons should note that any data submission overrides approved reweighting on a category-by-category basis; CMS will score any data submitted and those performance categories will contribute to surgeons’ final scores.

How To Apply for an Exception

To apply for either exception, surgeons should:

• Sign in to the QPP website with their Health Care Quality Information System (HCQIS) Access Roles and Profile (HARP) account
• Choose “Exceptions Application” from the menu on the left-hand side
• Click “Add New QPP Exception” on the right side of the screen
• Choose their exception type

For more information, visit the QPP Resource Library or contact QualityDC@facs.org.

Understanding PACs and Role of ACSPA-SurgeonsPAC

In Washington, DC, and across the country, elected officials are motivated by two things: the individuals who vote for them and those who communicate with them. Members may communicate with policymakers via SurgeonsVoice, and they can support their campaigns through contributions to the ACS Professional Association Political Action Committee (ACSPA-SurgeonsPAC).

A PAC collects and distributes financial contributions to support or oppose political candidates. PACs are typically organized around shared political goals and fall into two main categories:

• Connected PACs are sponsored by an organization, like a trade association or corporation, and must keep their funds separate from the organization's general funds to comply with Federal Election Commission (FEC) rules. Contributors to a connected PAC must be associated with the sponsoring organization.
• Nonconnected PACs operate independently and include federal PACs without corporate or labor sponsorship, leadership PACs, and PACs sponsored by partnerships or LLCs. 

ACSPA-SurgeonsPAC is a connected PAC with the purpose of promoting access to high-quality surgical care for patients and surgeons by supporting the election of federal officeholders who share the College’s perspective on relevant policies and priorities. The PAC’s activities include electing and educating federal officeholders, supporting healthcare professionals with relevant expertise, and ensuring compliance with FEC regulations. It operates under the governance of a diverse Board of Directors, composed of Fellows, Young Fellows, Associate Fellows, and Resident Members from various specialties, who assesses candidates for financial support in a balanced and nonpartisan manner. 

Given the evolving nature of healthcare policy, it is crucial for surgeons to engage with Congress on issues of importance such as physician payment, administrative burden, patient care, and more. ACSPA-SurgeonsPAC ensures that contributions are directed to candidates who support excellence in surgical care and exhibit professionalism when advocating on behalf of surgery.

Learn more about ACSPA-SurgeonsPAC.