American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Legislative and Regulatory Updates

51 Senators Urge Congressional Leadership to Stop Medicare Cuts

Last week, the Centers for Medicare & Medicaid Services issued its final rule for the Medicare Physician Fee Schedule, which will jeopardize patient care if implemented. On December 4, 50 senators sent a letter to leadership urging them to stop the impending Medicare payment cuts that will take effect in less than a month. Momentum in Congress is building as more senators and representatives recognize that holding providers harmless during a pandemic is the right thing to do as America continues to battle COVID-19.

David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons, noted, "While the country is dealing with the worst of COVID-19, CMS has set in motion a policy that will further strain the health care system. It is irresponsible to cut health care spending in the middle of the pandemic, and these cuts will hurt patients by limiting their access to quality care. We thank the senators for their leadership, and we pledge to work with Congress and all interested parties to work toward finding a solution that will protect patients by stopping these devastating cuts."

Read the letter. Additional key points:

  • The ACS believes the proposed Medicare Physician Fee Schedule finalized by CMS in December will jeopardize patient care by reducing access to care. This is ill-advised during a global pandemic given COVID-19 has already forced patients to delay routine medical care.
  • The cuts are set to take effect January 1, 2021, meaning Congress has only 24 days to stop these cuts.
  • The rule will cut payments for surgical care by up to 9 percent depending on the specialty, and further reduces the conversion factor—the basic starting point for calculating Medicare payments—by 11 percent. This is the lowest rate in 25 years.
  • A recent survey found that doctors will have to make tough choices on patient intake and staffing; one-third of doctors say they may reduce patient intake, and the vast majority of those who don't plan to alter patient intake will likely have to reduce time with patients, hire fewer nurses, or stop investments in surgical technology.

Write to Congress

Deadline for COVID-19-Related 2020 MIPS Extreme and Uncontrollable Circumstances Exception Applications Extended to February 1, 2021

CMS has extended the deadline for submitting 2020 Extreme and Uncontrollable Circumstances applications. If you are concerned that the COVID-19 pandemic has impacted your performance data for the 2020 Merit-based Incentive Payment System (MIPS) performance period, you can now submit an exception application until February 1, 2021. If you plan to submit an Extreme and Uncontrollable Circumstances Exception application for another hardship besides COVID-19 (for example, a natural disaster), you are still required to submit your application by December 31, 2020. 

By submitting an Extreme and Uncontrollable Circumstances application and citing COVID-19 as the reason for your application, you are eligible to receive reweighting of one or more MIPS performance categories—Quality, Improvement Activities (IA), Cost, Promoting Interoperability (PI)—to 0 percent of your overall MIPS score. It is important to note—if your application is approved, but you submit data for Quality, PI, or IA, it will override your performance category reweighting and you will be scored on the categories submitted. Therefore, if you have an approved application and do not want to be scored in those areas for which your application was approved, do not submit data for Quality and IA. Also, starting in 2020, APM entities now can apply for the Extreme and Uncontrollable Circumstances exception, but they must be reweighted in all categories. Since these MIPS data and these hardship applications can be submitted at both the individual and group level, it is important to check with your group practice to see what actions it plans to take.

To submit an Extreme and Uncontrollable Circumstances application, you must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application. With your HARP account information, sign in to qpp.cms.gov, select "Exception Applications" on the left-hand navigation, select "Add New Exception" and select "Extreme and Uncontrollable Circumstances Exception." You will be notified by e-mail if your application was approved or denied. If approved, your eligibility will be added to your profile on the QPP Participation Status Tool. Step-by-step directions on how to submit an application also can be found on the ACS website.

Visit the Extreme and Uncontrollable Circumstances Exception QPP webpages for more information and links to the application. CMS also offers an Exceptions Application Fact Sheet that provides more information about these exceptions.

CMS Releases New Policies for CY 2021 Quality Payment Program

On December 1, 2020, CMS released finalized provisions for the calendar year 2021 Quality Payment Program as part of the CY 2021 Medicare Physician Fee Schedule final rule. Required by the Medicare Access and CHIP Reauthorization Act of 2015, QPP implementation began in 2017. Next year marks the fifth year of the QPP; noncompliance in 2021 could result in a maximum payment cut of 9 percent in 2023. The QPP offers two pathways of compliance for eligible clinicians: the Merit-based Incentive Payment System, and Advanced Alternative Payment Models.

For the 2021 performance year (2023 payment year), CMS finalized multiple MIPS policies, including an increase to the overall performance threshold required to avoid a penalty (from 45 points in 2020 to 60 points in 2021), a 5 percentage point decrease to the Quality performance category weight (from 45 percent in 2020 to 40 percent in 2021), a 5 percentage point increase in the Cost performance category weight (from 15 percent in 2020 to 20 percent in 2021), the retirement of the APM scoring standard, and the implementation of a new reporting pathway for MIPS APM participants called the APM Performance Pathway. Notably, to acknowledge the major disruptions caused by the COVID-19 pandemic, CMS finalized a delay in the implementation of the MIPS Value Pathways, and instead finalized principles and criteria for MVP development. The implementation of MVPs will be delayed until the 2022 performance year or later.

The American College of Surgeons is evaluating the final rule and will submit comments to CMS. The final rule is available for public review, along with fact sheets on its QPP provisions. Contact qualityDC@facs.org with questions.