Major medical societies are urging the CMS to continue to allow a decades-old panel that hears appeals from providers who have been underpaid. The CMS, however, largely ignores its recommendations.
For more than 25 years, the CMS has convened a panel to review concerns when proposed relative value units, or RVUs, which are used to determine pay for physicians, were deemed inadequate by providers.
The panel is made up of a multispecialty group of physicians as well as a number of Medicare contracted medical directors. In recent years, the CMS began to tweak how often the industry could use the panel. In 2011, the agency modified the process to only consider appeals when new clinical information was available. It also began to independently review each of the panel's decisions when determining which values to actually finalize.
Last year, in a physician fee schedule rule, the agency announced it wanted to get rid of the panel altogether. In its place, the CMS would post proposed RVUs in rules and use those comment periods to get feedback on proposed values.
The change “offers stakeholders a better mechanism and ample opportunity for providing any additional data for our consideration, and discussing any concerns with our interim final values, than the current refinement process,” the agency said in a notice. It also provides greater transparency because comments on rules are made available to the public, the CMS argued.
The American Medical Association and other groups are now urging CMS to not only keep the panel around, but also allow it to operate the way it did before the 2011 tweaks.
“Absent any independent mechanism for appeal, CMS officials are free to make valuation decisions without having to provide a compelling rationale when rejecting relative value recommendations,” the AMA, American College of Physicians, American College of Cardiology, American College of Emergency Physicians and other groups said in a letter (PDF) to CMS Acting Administrator Andy Slavitt.
Since the implementation of the 2011 changes, the CMS has rejected the majority of requests for refinement panel review and only accepted 36% of recommendations from the panel. Historically, there were years when every appeal made to the panel resulted in a revised RVU, according to an analysis by the AMA.
