Battle Brews as AMA, 150 Health Groups Oppose CMS Payment Rate Proposal

Roughly 150 top healthcare organizations, led by the American Medical Association, have united in opposition to the Centers for Medicare & Medicaid Services’ proposed collapse of payment rates for certain office visits.

But in a letter to CMS Administrator Seema Verma, the groups also said they supported the agency’s proposal to cut documentation requirements, noting that it has correctly targeted “note bloat” as a barrier to proper care and information retrieval.

Both efforts are part of Patients Over Paperwork, a series of proposed rule changes and initiatives affecting Medicare billing and beyond. Under Verma, CMS has made the drive to reduce administrative burden a key component of its plans, echoing the president’s desire to cut red tape.

>> READ: CMS Says New Rule Could Save Clinicians 51 Hours of Paperwork Per Year

The lukewarm reception from the American Medical Association and hundreds of other groups, from the American College of Cardiology and the Society of Thoracic Surgeons to medical societies from all 50 states, reflected the mixed bag of praise and criticism that has bubbled up since mid-July, when CMS unveiled its proposal.

The portion of the rule change that frustrated healthcare organizations centers on the consolidation of tiered office visit reimbursement rates, from eight to two each. The opposition wrote that such a move could result in “unintended consequences” and leaves unanswered questions.

“We oppose the implementation of this proposal because it could hurt physicians and other healthcare professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care,” they said.

The proposed multiple service payment reduction policy could further harm providers, and services such as chemotherapy administration could be hit particularly hard, the writers claimed.

By being required to provide only a certain level of documentation no matter their patients’ level of care, clinicians would save time and effort replicating medical histories, CMS officials have said. They have argued that payments to providers would decrease by 1 or 2 percent, and healthcare groups would save money on labor-intensive billing processes.

Ultimately, the letter writers called for American Medical Association-led workgroups to examine evaluation/management (E/M) changes and payments so that CMS may introduce new rules in time for 2020. The existing proposal would go into effect next year, in 2019.

“The medical community wants to help CMS work through the complicated issues surrounding the appropriate coding, payment and documentation requirements for different levels of E/M services,” the writers said.

Still, the groups applauded other portions of CMS’s proposal, including changes to patient history documentation, redocumentation requirements and removing the need to justify home visits.

The organizations said these policies would “streamline documentation requirements, reduce note bloat, improve workflow and contributor to a better environment for healthcare professionals and their Medicare patients.”

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