The Centers for Medicare and Medicaid Services (CMS) on July 13 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.

Highlights from the proposed rule include:

Physician Fee Schedule

• Updates to work and/or practice expense (PE) values for new/revised codes describing exclusion of left atrial appendage, harvest of upper extremity artery, external cardiovascular device monitoring, electrophysiological 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 (PA) services, opioid treatment program (OTP) policy, rural health clinics (RHCs) and federally qualified health centers (FQHCs), 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.
• A request for information (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 (AUC) Program penalty phase start date to Jan. 1, 2023 or the Jan. 1 following the end of the COVID-19 Public Health Emergency (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. Highlights include:

• A proposed implementation timeline for the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) and APM Performance Pathway (APP) 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 (e.g., 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 APP 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% 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 5 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 (e.g., 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.

ACC staff are reviewing the proposed rule to identify additional topics of interest to members and will submit written comments at the end of the summer. The proposed 2022 Hospital Outpatient prospective payment system rule will follow soon. More information will be forthcoming in the Advocate newsletter and on ACC.org in the coming weeks. Additional CMS fact sheets are available here and here and here.

Not long before the final rules are released in the fall, experts will discuss federal legislative and regulatory topics at ACC's 2021 Legislative Conference being held Oct. 3 – 5 in Washington, DC. Don't miss this opportunity to learn about hot button issues facing cardiologists and to ensure the voice of cardiology is heard on Capitol Hill. Access additional information here.

Clinical Topics: Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, COVID-19 Hub, Noninvasive Imaging, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Controlled Substances, Analgesics, Opioid, Accountable Care Organizations, Public Health, Aortic Coarctation, Electronic Prescribing, Rheumatology, Atrial Appendage, COVID-19, Drug Costs, Imaging, Three-Dimensional, Outpatients, Quality Indicators, Health Care, Rural Health, Medicare, Fee Schedules, Anesthesia, Emergency Medicine, Telemedicine, Malpractice, Critical Care, Physician Assistants, Hospitals, Policy, Cardiac Catheterization, Stroke, Prospective Payment System, Arteries, Lower Extremity, Electronics, Disease Management, Endovascular Procedures, Upper Extremity, Technology, Vaccines, Positron-Emission Tomography

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