September 6, 2022

APMA submitted comments in response to CMS’ proposed changes to the Medicare Physician Fee Schedule and the Quality Payment Program for 2023. In our extensive comments, we focused on the following concerns, among others:

• Medicare Conversion Factor. APMA has significant concerns beyond the proposed reduction for 2023. We believe these proposed reductions reflect structural problems within the Physician Fee Schedule (PFS), including requirements for budget neutrality and statutorily-mandated low (or nonexistent) annual payment updates—that have long contributed to undervaluation of physician services. APMA urged CMS to pursue opportunities to mitigate the impact of the proposed conversion factor reductions for 2023, including working with Congress and other stakeholders to enact a legislative remedy and enact real reform to the PFS that ensures physicians can consistently rely on sustainable payments over the long term.
• Cellular and/or Tissue-based Products Services. CMS is proposing an overhaul of the nomenclature, coding, and payment of cellular and/or tissue-based products (CTP), also referred to as skin substitute products, effective January 1, 2024. APMA fears these changes will impact patient access and increase the number of amputations and infections for patients with chronic non-healing wounds. We do not support CMS’ proposed policies and urged CMS to withdraw the proposal. At a minimum, APMA urged that CMS should delay implementation until key questions are addressed and stakeholders have had time to fully analyze the proposed changes.
• Telehealth. APMA recommends strongly that CMS work with Congress to permanently finalize and adopt many of the changes related to telehealth that are scheduled to end with the end of the public health emergency (PHE). In particular, we urge CMS to work with Congress to permanently remove the Section 1834(m) geographic and originating site restrictions to ensure that all patients can access care where they are, where clinically appropriate and with appropriate beneficiary protections and guardrails in place.
• Global Surgical Package Valuation. APMA does not agree with CMS’ assertion that current valuations of the global packages reflect certain E/M visits that are not typically furnished in the global period, and thus are not occurring. APMA does not support CMS’ contemplation of significant changes to payment for global surgical services. We, instead, agree with the RUC in recommending that CMS instead indicate specific codes which it believes are potentially misvalued so that the RUC may address individual services without penalizing all surgeons and all services with a global period.
• MIPS Value Pathways (MVPs) Creation Process. APMA urged CMS to better support the development of additional measures to populate MVPs—particularly where there are notable measure gaps—through technical and financial assistance, as well as through the adoption of policies that incentivize the use of such measures. Currently numerous specialties, including podiatry, do not have applicable MVPs available to them.
• MIPS Minimum Performance Threshold Increase. APMA urged CMS to contemplate the effect the ongoing PHE and COVID-19 hardship exceptions will have had on providers’ ability to participate successfully at the high level now statutorily required to avoid a MIPS penalty. APMA urged CMS to work with Congress to reassess this ramp-up and also contemplate how to ease new Medicare providers into the MIPS program.

Read the full letter at www.apma.org/commentletters. Contact the APMA Health Policy and Practice Department with any additional concerns or comments.