AMA gives mixed reaction to CMS physician fee changes for 2017

The initial reaction of the American Medical Association (AMA) to the proposed physician fee schedule for 2017 called the rule “a mix of meritorious and flawed proposals.”

One portion of the 856-page proposed rule the AMA liked is the expansion of the diabetes prevention model. CMS would expand the diabetes prevention program (DPP) into Medicare in 2018, allowing beneficiaries who meet certain prediabetic thresholds to participate.

“Expansion of the DPP model will help at-risk seniors and people with disabilities lower their risk factors and prevent their condition from advancing to type 2 diabetes,” the AMA wrote.

The association also approved of the many Current Procedural Terminology (CPT) code changes outlined by CMS, covering services such as mammography to non-face-to-face prolonged evaluation and management services.

“CMS is proposing to begin compensating physicians for existing codes for prolonged services and complex chronic care management services, as well as new codes for cognitive impairment assessment and care plan services and psychiatric collaborative care management,” the association wrote. “The AMA will continue to explore and recommend additional models of innovative care that improve the health of Medicare patients.”

What it didn’t like were sections on more frequent information collection and eliminating a payment increase.

“The AMA has serious concerns about the proposal to collect information on every 10-minute increment of patient care provided by physicians as part of activities before and after each surgery/procedure, which can occur in the hospital, office, or via email/telephone,” the AMA wrote. “This proposal goes far beyond Congress' intent and will be extremely and unnecessarily burdensome, not only to surgeons but to all physicians who deliver the more than 4,000 services subject to this massive proposal.”

The association added that these requirements would be particularly difficult for physicians to deal with while simultaneously adapting to new standards under the Medicare Access & CHIP Reauthorization Act (MACRA).

The focus of CMS’s statements on the fee schedule was the increase in payments to primary care and family physicians, like increasing the reimbursement for office visits for patients with mobility-related disabilities from $73 to $119. The AMA said it supports efforts to improve access for those patients, but objected to how the agency proposed to pay for it.

“The AMA also opposes CMS's plan to eliminate the physician payment increase that Congress provided for 2017 in the MACRA legislation and repurpose that money to fund a newly proposed add-on payment for services provided to patients with mobility impairments,” the association wrote, adding “there is no justification for funding the service with an across-the-board cut in payment rates.  The proposal also raises program integrity questions and seems likely to increase out-of-pocket costs for patients with disabilities.”

The AMA’s criticisms stood in contrast with the largely positive reaction to the rule from the American College of Radiology.

The AMA promised to make more detailed comments before the September 6 deadline.