CMS Releases Proposed 2022 Medicare Physician Fee Schedule and OPPS Rules
News | Published: Monday, July 19, 2021
In mid-July, the Centers for Medicare and Medicaid Services (CMS) released 2022 proposed rules for the Physician Fee Schedule and Outpatient Prospective Payment System. Highlights of note for cardiology are detailed below. MedAxiom and ACC staff are reviewing the proposed rules to identify additional topics of interest to members and will submit written comments at the end of the summer. Stay tuned to MedAxiom.com for additional analysis in the coming days and weeks.
Don't miss an upcoming CV Transforum Fall’21 session, Healthcare Reform: Transition to Value and Regulatory Update, where MedAxiom and ACC experts will discuss advocacy topics in depth. Also, attend ACC’s 2021 Legislative Conference, Oct. 3 – 5 in Washington, DC, to learn about hot button issues facing cardiologists and to ensure the voice of cardiology is heard on Capitol Hill.
2022 Outpatient Prospective Payment System Proposed Rule
On July 19, CMS released the 2022 Outpatient Prospective Payment System (OPPS) proposed rule. The outpatient rule indicates a 2.3% payment update for hospitals and other proposals. The CMS fact sheet is available here.
Generally, proposals in this cycle align with addressing health equity gaps, COVID-19 Public Health Emergency (PHE), health system transparency, and promoting safe patient-centered care.
Proposed rule highlights include:
- CMS proposes several modifications to the Hospital Price Transparency final rule, which was effective Jan. 1, 2021. Among others, changes include an increase in civil monetary penalties, standardization of machine-readable files, and clarifications on the online price estimator tool.
- The Agency solicits comments via the Rural Emergency Hospital (REH) Provider Type Request for Information (RFI). This RFI addresses health and safety standards, payment policies and quality measures for REHs.
- CMS proposes use of CY2019 claims data for CY2022 OPPS and Ambulatory Surgical Center (ASC) Payment System ratesetting due to the PHE.
- Due to overwhelming stakeholder feedback in the CY2021 rulemaking cycle, CMS proposes to halt the elimination of the Inpatient Only (IPO) List for CY2022. CMS plans to add the 298 services removed from the IPO list last year. Additionally, CMS proposes to codify the longstanding criteria for removal of procedures from the IPO list.
- CMS proposes to reinstate the ASC Covered Procedures List (ASC CPL) criteria, and plans to remove the ASC CPL 258 of the 267 procedures, which were added in CY2021. Part of this plan also includes a proposal to adopt a nomination process, where an external party could nominate a surgical procedure to be added to the ASC CPL in the next applicable rulemaking cycle.
- The Agency proposes non-opioid pain management drug or biological that functions as a surgical supply in the ASC setting would be eligible for separate payment when FDA approved and indicated for pain management or as an analgesic.
- CMS solicits comments on temporary policies for the PHE for COVID-19 to include: mental health services, practice patterns that rely on communication technology, direct supervision requirement for cardiac rehabilitation/intensive cardiac rehabilitation to include virtual presence through audio/video real-time communications technology, and HCPCS code C9803 ((Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source).
- CMS proposes multiple device pass-through payments, including preliminary approval of the Shockwave C2 Coronary Intravascular Lithotripsy (IVL) catheter application.
- CMS proposes changes to the Hospital Outpatient Quality Reporting and ASC Quality Reporting Programs to further meaningful measurement and reporting of health disparities based on social risk factors, race, ethnicity and more.
- Finally, CMS seeks comments on future plans to modernize the digital quality measurement enterprise.
2022 Medicare Physician Fee Schedule Proposed Rule
On July 13, CMS released the proposed 2022 Medicare Physician Fee Schedule, addressing Medicare payment and quality provisions for physicians in the next fiscal year. Under the proposal, physicians would see a decrease of $1.31 in the conversion factor on Jan. 1, 2022, going from $34.89 to $33.58. CMS estimates that the physician rule would decrease payments to cardiologists by about 2% from 2021 to 2022 through updates to work, practice expense, and malpractice RVUs. This estimate is based on the entire cardiology profession and can vary widely depending on the mix of services provided in a practice. CMS fact sheets are available here and here.
Proposed rule highlights include:
Physician Fee Schedule
- Updates to work and/or practice expense values for new/revised codes describing exclusion of left atrial appendage, harvest of upper extremity artery, external cardiovascular device monitoring, electrophysiological (EP) evaluation, endovascular repair of aortic coarctation, 3D imaging of cardiac structures, percutaneous cerebral embolic protection, cardiac catheterization for congenital defects, and cardiac ablation services bundling. Work RVU proposals for EP ablation services appear significant and more information will be available once CMS posts supporting data tables.
- Several proposals that take into account the recent changes to E/M visit codes, which took effect Jan. 1 and are explained in the AMA CPT Codebook. Specifically, the rule proposes a number of refinements to current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians involving residents.
- Details regarding telehealth services, physician assistant services, opioid treatment program policy, rural health clinics and federally qualified health centers, electronic prescribing of controlled substances, drug pricing information reporting, pulmonary rehabilitation, Medicare Shared Savings Program, Open Payments Financial Transparency Program, and Medicare Provider Enrollment, among other topics.
- CMS is also soliciting comments on vaccine administration services, aspects of telehealth services, the Shared Savings Program, digital quality measurement, clinical notes and more for the 2022 calendar year.
- An RFI to gather public input on CMS’ intended transition to digital quality measurement by 2025, aligning with an RFI in the 2022 IPPS proposed rule.
- A proposal to remove two national coverage determinations (NCDs), including PET NCD 220.6 that includes myocardial PET, based on the criteria developed in last year's final rule addressing outdated NCDs.
- A proposed delay in the Appropriate Use Criteria Program penalty phase start date to Jan. 1, 2023, or the Jan. 1 following the end of the COVID-19 PHE, whichever is later. This would allow CMS time to address implementation and claims processing issues as part of future rulemakings and also takes into account the continued impact of COVID-19.
Medicare Telehealth and Other Services Involving Communications Technology
- Proposed policy changes that would allow certain services added to the Medicare telehealth list to remain on the list through Dec. 31, 2023, and allow time for evaluating whether the services should be permanently added to the telehealth list following the COVID-19 PHE.
2022 Quality Payment Program Performance Period
As clinicians across the country continue to respond to COVID-19, CMS is proposing a number of significant changes to the Quality Payment Program (QPP) in 2022.
- A proposed implementation timeline for the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) and APM Performance Pathway in the 2023 performance period. CMS proposes seven MVPs to be available with the beginning of the 2023 performance period, including rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair (i.e., knee replacement), emergency medicine, and anesthesia.
- A proposal that MVP Participants register for the MVP (and as a subgroup if applicable) between April 1 and Nov. 30 of the performance year, or a later date as specified by CMS.
- A proposal to allow MIPS eligible clinicians to report the APM Performance Pathway as a subgroup beginning with the 2023 performance year. CMS proposes requiring multispecialty groups to form subgroups to report MVPs beginning in 2025.
- A proposal to consider retiring traditional MIPS, where it would no longer be available by the CY 2028 MIPS performance period/2030 MIPS payment year. Any decisions would be made as part of future rulemaking.
- A proposal to establish a CY 2022 performance threshold using the mean final score from the 2017 performance period/2019 MIPS payment year data, which would result in a performance threshold of 75 points.
- Proposed performance category weights of 30% for the Quality performance category, 30% for the Cost performance category, 15% for the Improvement Activities performance category, and 25% for the Promoting Interoperability performance category.
- A proposal to continue the 10-point complex patient bonus for the CY 2021 MIPS performance period and revise the complex patient bonus to better target clinicians who treat a higher caseload of more complex and high-risk patients starting in CY 2022.
- A proposal to lengthen the transition to Accountable Care Organizations (ACO) eCQM/MIPS CQM quality measure reporting, which requires all-payer data, by extending the CMS Web Interface as an option for two years for ACOs.
- Proposed updates to quality measure scoring to remove end-to-end electronic reporting and high-priority measure bonus points as well as the 3-point floor for scoring measures (with some exceptions for small practices), and a proposal to add five new episode-based cost measures.
- A proposal to update the Improvement Activities inventory by adding new activities about health equity and standardizing language related to equity across the improvement activities inventory, and a proposal to revise reporting requirements under the Performance Interoperability performance category.
- Beginning in the 2023 performance year, CMS proposes all third party intermediaries (i.e., QCDRs, qualified registries and health IT vendors) support MVPs relevant to the specialties they support, as well as subgroup reporting.
- A requirement for a QCDR measure to be fully tested at the clinician level, beginning with the 2022 performance period, in order to be included in an MVP.