Healthcare Business News

MGMA, AAFP urge changes on doc fee schedule

By Andis Robeznieks
Posted: September 2, 2011 - 1:00 pm ET

The CMS' proposed Medicare Part B Physician Fee Schedule for 2012 (PDF) needs to be revised to relieve information-technology-related administrative burdens on practices and adjust how primary-care services are valued, according to two organizations of healthcare professionals.

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In a 17-page letter to CMS Administrator Dr. Donald Berwick, the Medical Group Management Association argues that if, for example, physicians meet electronic health-record system meaningful-use requirements and qualify for EHR subsidies through the CMS' IT incentive programs, they should automatically qualify for bonuses under the Physician Quality Reporting System program and be exempt from penalties related to electronic prescribing.

“It is clear that significant overlap exists between the 2012 Medicare eRx initiative and Stage 1 of the Medicare EHR incentive program,” Dr. William Jessee, MGMA president and CEO, wrote in the letter. “CMS should use its regulatory authority to deem all physicians that meet meaningful-use requirements (and therefore e-prescribe under that program) as also successfully meeting all eRx requirements in each corresponding performance year.”

The MGMA also requested that the CMS reconsider its decision to not offer an appeals process for physicians and practices who the CMS determined to not have met the e-prescribing requirements or qualify for hardship exemptions. It also opposed a CMS proposal to change the definition of “group practice” to include only practices of more than 25 doctors.

“This is a step backward,” wrote Jessee in opposing the definition change.

In a 26-page letter, American Academy of Family Physicians board Chairwoman Dr. Lori Heim wrote that the CMS should establish a more timely review of “misvalued services,” hold vendors accountable for successful data submission, and institute payment for telephone calls, online medical evaluation and team conferences.

“CMS should work with the medical community to develop and implement the patient-centered medical home, reward prevention and wellness, eliminate fragmentation and duplication and produce a cohesive system of care that prevents unnecessary complications from acute or chronic illness, hospitalizations and other avoidable expenses,” Heim wrote.

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