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  • Washington Highlights

    AAMC Comments on 2023 Medicare Physician Fee Schedule Proposed Rule

    Ki Stewart, Senior Policy and Regulatory Analyst
    For Media Inquiries

    The AAMC submitted comments to the Centers for Medicare & Medicaid Services (CMS) on Sept. 6 in response to the 2023 Medicare Physician Fee Schedule proposed rule. In the comments, the AAMC urged the agency to prevent steep cuts to physician payments by supporting efforts to persuade Congress to pass legislation that provides a 4.5% conversion factor adjustment for 2023 and waives the 4% statutory pay-as-you-go (commonly referred to as PAYGO) requirement.

    In its comments, the association supported the proposed one-year delay of the time-based definition of substantive portion for split (or shared) visits and recommended that the CMS finalize an alternative policy that would allow billing of those visits based on who performs more than 50% of the time or who performs the key medical decision-making component of the service. The AAMC supported the agency’s proposal to adopt the coding changes and payment rates for “Other E/M services” recommended by the Relative Value Scale Update Committee, or RUC.

    The AAMC described the clinical benefits of telehealth and urged the CMS to continue to pay providers at the same rate for telehealth services as in-person services to promote greater access to care. The association also supported the proposed 151-day extension after the end of the public health emergency of the COVID-19 telehealth flexibilities provided for in the Consolidated Appropriations Act, 2022 and recommended that the agency permanently implement these policies. These COVID-19 flexibilities include payment for telehealth services in any geographic location (including the patient’s home), payment for audio-only technology, the expanded definition of eligible providers to include physical therapists, occupational therapists, speech-language pathologists, and audiologists of telehealth services, payment for telehealth services provided by Federally Qualified health centers and Rural Health Clinics, and delays of the in-person requirements for mental health services.

    In its comments, the AAMC supported the CMS’ proposal to expand coverage for opioid use disorders and behavioral health services, including creating a new G Code for general behavioral health integration services performed by clinical psychologists or clinical social workers to account for monthly care integration.

    The AAMC also responded to proposals for changes to the Medicare Shared Savings Program, including support for slowing the path to risk, adding a health equity adjustment for quality scoring, and incorporating an alternative quality performance standard.

    On the Quality Payment Program, the AAMC urged the CMS to make Merit-based Incentive Payment System, or MIPS, Value Pathway reporting voluntary, allowing clinicians to determine which reporting option is most meaningful and least burdensome. The association generally supported subgroup reporting and recommended that the agency explore solutions to enable subgroup reporting across all measures and performance categories in the future to obtain more meaningful performance information. Given concerns with attribution, risk adjustment, and the impacts of the COVID-19 public health emergency, the AAMC recommended that the agency weight the cost performance category at 20% or less. The AAMC urged the CMS to include in its legislative agenda support for the continuation of the Advanced Alternative Payment Model 5% bonus, which would terminate in performance year 2023 without congressional action.

    The AAMC separately signed a joint comment letter in response to Accountable Care Organization proposals included in the 2023 Medicare Physician Fee Schedule proposed rule [refer to related story].

    The CMS is expected to issue a final rule by Nov. 1, which will include responses to the public comments and finalize policies.