ACP: Proposed Medicare QPP Changes Fall Short of Meeting Needs of Struggling Practices

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Although pleased with certain aspects of the proposed rule, ACP calls for more broad-scale protections for practices struggling due to the COVID-19 pandemic

Sept. 11, 2020 (ACP) – The American College of Physicians is urging federal officials to introduce additional significant accommodations to the Medicare Quality Payment Program (QPP) for the 2021 performance year to continue to meet the needs of struggling medical practices during the coronavirus pandemic.

“Physician practices are reeling this year thanks to the COVID-19 pandemic, and they are having to make major shifts in how they conduct business,” said Dr. Jacqueline W. Fincher, ACP president. “Right now, practices need support – not penalties – as they continue to recover and rebuild. We hope that the Centers for Medicare & Medicaid Services (CMS) will hear our concerns and that we can work with them to include more effective accommodations for physician practices in the final rule.”

CMS revises the QPP every year as part of the Medicare Physician Fee Schedule rulemaking process. In early August, CMS released the proposed changes for 2021 and asked the public for input before finalizing them.

ACP is concerned about gaps in the proposed regulations, said Suzanne Joy, senior associate of regulatory affairs. “Practices are continuing to struggle with historically low revenues and increased demand due to the COVID-19 public health emergency,” she said. “We'd like to see more broad-scale protections, such as an uncontrollable circumstances exception for the Merit-Based Incentive Payment System (MIPS) for the 2021 performance year, as they did for 2019 and 2020.”

“We'd also like to see similar protections on the Alternative Payment Model (APM) side. While we appreciate the model-specific flexibilities, clinicians who entered into APMs –particularly risk-bearing APMs – should be receiving extra support right now, not be financially penalized for falling short of financial benchmarks or performance targets during a global pandemic,” Joy continued. “We'd also like to see the Department of Health and Human Services Secretary Alex Azar exert his authority to lower the patient count Qualified APM Participant (QP) threshold. APM development has been a bit slower than expected, and if it does increase next year as currently proposed, far fewer clinicians will achieve QP status, which means missing out on the Advanced APM bonus.”

ACP is pleased with certain aspects of the proposed rule, including:

  • Moving ahead with the MIPS Value Pathway (MVP), though CMS does propose to delay initial implementation from 2021 to 2022. “ACP has long advocated for more alignment in MIPS, and we were one of only a few organizations to submit our own MVP proposals to CMS earlier this year. We hope the agency will continue to collaborate with us and other stakeholders as it moves forward with MVP development and implementation,” Joy said.
  • The incorporation of telehealth services toward cost measure calculations and patient attribution in MIPS. “This is important given the proliferation of telehealth over the last several months due to COVID-19,” Joy said. “However, CMS does need to make necessary updates to measure specifications, and allow the telehealth modifier to be reported for electronic quality measures, which currently is not feasible.”
  • Adjustments to reduce quality reporting burden for Medicare Shared Savings Program Accountable Care Organizations. “ACP generally supports efforts to reduce reporting burden, though we do have some concerns with some of the individual proposals,” Joy said. “We also feel the timeframe is ambitious given the magnitude of the changes and will be advocating for CMS to delay these changes until 2022.”
  • A new informal review process for Qualified APM Participant determinations. “We're excited to finally have this since we've asked for it for years,” Joy said.

ACP is currently reviewing the rule, gathering feedback from internal policy committees, and talking to fellow stakeholder allies, including members of its Council of Subspecialty Societies. “We will be submitting robust feedback to CMS ahead of the Oct. 5 deadline,” Joy said. “According to CMS, the final rule likely will not be out by Nov. 1 this year due to delays related to COVID-19, so we'll have an even shorter runway to work with. ACP will be standing ready to educate our members and help prepare them for all the changes ahead of Jan. 1.”

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