American College of Rheumatology Responds to 2022 Medicare Physician Fee Schedule Proposed Rule September 15, 2021 Rheumatology leaders are encouraged by continued implementation of E/M coding changes, telehealth flexibilities and rheumatology-specific MIPS Value Pathway, but have concerns regarding conversion factor reductions and the CMS EHR interoperability & digital quality measures proposal WASHINGTON, DC – In comments submitted to the Centers for Medicare and Medicaid Services (CMS), the American College of Rheumatology (ACR) shared its perspective on the CY 2022 Medicare Physician Fee Schedule and Quality Payment Program proposed rule. “We are especially appreciative of CMS’ continued recognition of the value of complex care provided by rheumatologists and other cognitive care specialists by continuing to operationalize the Evaluation and Management (E/M) coding changes that were set in motion over the last few years. As our nation's healthcare system continues to navigate the challenges of a global pandemic, we also appreciate the policies and flexibilities set forth by CMS to help alleviate these challenges while we all work to provide quality care for our patients,” said David Karp, MD, PhD, president of the ACR. “In light of ongoing volatility and unknowns in the healthcare system, we would also like to share our concerns with some other aspects of the proposed rule – especially the proposed decrease in the conversion factor, CMS’ proposed implementation of the rheumatology MIPS Value Pathway and a new proposal for EHR interoperability and digital quality measures.” The ACR’s specific comments and concerns are outlined as follows: Evaluation and Management Services The ACR appreciates CMS’ ongoing commitment to implementing recent changes to E/M codes that more appropriately reflect the value of cognitive specialists and urges the agency to continue monitoring how the updated codes are operationalized. The ACR also appreciates the proposed rule’s revisions to the long-standing policy on billing for split (or shared) visits but wants to ensure that these changes don’t become burdensome for providers, especially as it relates to time tracking for the "substantive performance" of the provider, as this can introduce the potential for billing errors. Telehealth Flexibilities CMS has proposed extending several of the telehealth flexibilities that were implemented at the start of the public health emergency through the end of 2023. The ACR appreciates this additional flexibility and recommends that the direct supervision waiver allowing a supervising physician to serve patients using real-time, interactive audio-video technology be made permanent. This would immediately provide timely access to cognitive services for Medicare beneficiaries and relieve an undue burden to an aging population. The ACR also supports CMS’ proposal to permanently adopt a code (G2252) for an extended virtual check-in. This allows a provider to briefly check in with an established patient using any form of synchronous communication technology, including audio-only, and will be especially beneficial to patients in rural areas. Conversion Factor Reduction, Physician Work and Practice Expense (PE) Relative Value Changes The ACR shares the concerns raised by many specialty provider groups about CMS’ proposal to reduce the conversion factor by 3.75% in 2022 and urges the agency to maintain the current rate at least through 2023. The proposed reduction comes at a time when physician practices and hospitals are facing unprecedented uncertainty about their futures amid the COVID-19 pandemic. Implementing reductions now would have a damaging impact on an already strained system. Concerning the proposed updates to the Relative Value Units (RVUs), the ACR recognizes that CY 2022 is the final year of a four-year transition period to update the practice expense (PE) component with the latest pricing data for supplies and equipment. In conjunction with this final year of the equipment pricing update, CMS is also proposing an update to the clinical labor pricing component in CY 2022, which could result in temporary distortions for provider reimbursement. To minimize disruptions to physician practices, the ACR recommends CMS use a similar four-year transition to implement the clinical labor pricing update. EHR Interoperability & Digital Quality Measures While the ACR is overall encouraged by CMS’ efforts to broaden the standardization of clinical data and increase electronic health record (EHR) interoperability, the ACR has several concerns with how the agency’s proposed recommendations will impact practices – particularly smaller practices with fewer financial resources. As a next step for moving forward, the ACR recommends CMS conduct an environmental landscape assessment of EHR software capabilities that should consider factors such as costs to practices, specialty-specific templates and reports, registry participation and patient portal access. This should help establish a clearer picture of practices’ reasonable ability to meet CMS’ proposed digital health goals and avoid a situation where providers are held accountable for factors that are beyond their control. Rheumatology MIPS Value Pathway (MVP) The ACR is pleased that the proposed rule includes a new MIPS Value Pathway (MVP) for rheumatology as proposed by the ACR and looks forward to working with the agency to ensure that it is implemented successfully. However, the ACR has several concerns with the proposed rollout of the MVP program and the lack of details that have been provided thus far. In particular, the ACR recommends delaying setting a deadline for sunsetting traditional MIPS until the agency can evaluate the success of implementing MVPs. For more details, view the ACR’s full comment letter. Media Contact: Jocelyn Givensjgivens@rheumatology.org (404) 929-4810 ###Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves over 7,700 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.