Lawmakers Voice Concern with CMS Rulemaking Process

On April 17, 47 House lawmakers sent a letter to CMS Administrator Marilyn Tavenner voicing concern with the current process for establishing changes to Medicare Part B physician payments. Specifically, the letter cited the failure of CMS to include changes in payments in the proposed rule as a result of the misvalued codes initiative. Consequently, because changes are first revealed in the final rule, medical societies have no opportunity to analyze and comment on before they take effect. Eleventh-hour payment modifications also afford practices little time to assess and adjust for their impact. On April 8, a similar letter was sent by House Democratic committee leaders that requested that CMS follow the full notice and comment rulemaking process, including notice of proposed rates in the proposed regulation and a 60-day comment period.

In the Senate, a similar sign-on letter effort, which is supported by ASNC and 27 other medical societies, is underway being led by Sen. Kelly Ayotte (R-NH). ASNC members are encouraged to contact their senators and ask them to sign the letter by June 12.

Changes to CMS' rate-setting process is particularly important given that this year, as part of the latest Sustainable Growth Rate (SGR) "patch," Congress expanded the screens CMS has at its disposal to identify potentially misvalued codes. The expansion includes, but is not limited to, codes that account for a majority of physician fee schedule spending and those which have experienced the fastest growth. Beginning in 2017 and through 2020, the bill sets an annual target of 0.5 percent in savings that must be achieved from misvalued Medicare physician fee schedule services. If the target is met, the savings are redistributed to other services, and excess savings can carry forward to future years. If the target is not met, across-the-board cuts apply, which are not budget-neutral. The bill's language does not protect codes that have been recently surveyed.