AMA Timeline Process Revision Letter

June 3, 2014

Sean Cavanaugh
Deputy Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
Room C5-01-14
7500 Security Boulevard
Baltimore, MD 21244-1850

Dear Mr. Cavanaugh:

In response to concerns that have been raised about the current process for adopting changes in Medicare’s physician fee schedule, the American Medical Association (AMA) has held a number of conversations with various medical specialties, as well as staff, at the Centers for Medicare & Medicaid Services (CMS). The attached document offers a revised timeline for submission of recommendations from the AMA/Specialty Society RVS Update Committee (RUC) that we believe would make it possible for CMS to address the concerns that have been raised, while also ensuring that codes for new technology could still be considered in a timely manner.

As you may know, a key complaint that has arisen about the current process involves the timing for publishing and implementing modifications in Relative Value Units (RVUs) for existing services, particularly those that are facing reductions in RVUs and Medicare payments. Currently, CMS publishes RVU changes in an interim final rule typically issued in early November and effective on January 1st, which means that the changes will be in place for a year before any modifications are possible. The affected specialties do not have an opportunity to comment on the proposed changes before they become final and the affected physicians have only two months to prepare for what can be significant payment cuts.

The modified timeline laid out in the attached document envisions a process that would deliver RUC recommendations in time for CMS to consider the recommendations, potentially modify them, and then publish CMS-proposed RVUs in a Notice of Proposed Rulemaking that is usually published in late June or early July. New technology/services or others where there is some immediate need for publication would still be published as interim final values in November. At this point, we are far enough into the 2015 and 2016 cycle for making RVU and coding changes, that we believe the earliest that this process could be fully in place is with the publication in July 2016 of the proposed 2017 fee schedule, which would take effect on January 1, 2017.

We want to do whatever we can to make this process work for all parties, and we look forward to discussing this issue with you further. Please contact Sherry Smith, Director, Physician Payment Policy Systems if you have any questions at sherry.smith@ama-assn.org or 312-464-5604.

Sincerely,

James L. Madara, MD


Attachment

Potential Modifications to Current Procedural Terminology (CPT®)/AMA/Specialty Society RVS Update Committee (RUC) Cycle

In order to meet our shared goal of providing greater opportunity for public comment on modifications in Relative Value Units in Medicare’s physician fee schedule (MFS), the AMA is proposing to CMS that the following schedule would be plausible, allowing for additional comment opportunities, while ensuring that coding proposals for new technology can still be considered in a timely manner.

For purposes of demonstration, the cycle for CPT and MFS 2017 is illustrated.

May 14-16, 2015 CPT Meeting

• Deadline for submission: February 13, 2015;

• Consider all proposals, including those related to relativity assessment work (code bundles, etc.)

 

October 1-4, 2015 RUC Meeting

• Review ALL issues from the May 2015 CPT Meeting;

• Review relativity assessment issues unrelated to code changes

 

November 2015

• RUC submits recommendations to CMS for ALL issues discussed at October 2015 RUC Meeting

 

October 8-10, 2015 CPT Meeting

• Deadline for submission: July 8, 2015;

• Consider all proposals, including those related to relativity assessment work (code bundles, etc.)

 

January 28-31, 2016 RUC Meeting

• Review ALL issues from the October 2015 CPT Meeting;

• Review relativity assessment issues unrelated to code changes

 

Early March 2016

• RUC submits recommendations to CMS for ALL issues discussed at January 2016 RUC Meeting

 

February 4-6, 2016 CPT Meeting

• Deadline for submission: November 4, 2015;

• While the items listed below could be considered at any CPT Editorial Panel meeting, they will be the primary agenda items considered at the February CPT Meeting: • Consider coding proposals unrelated to Medicare Physician Payment Schedule (clinical lab fee schedule services, including all molecular pathology (MoPath); vaccine codes, Category II and III codes);

• Consider editorial revisions to existing codes;

• Consider coding proposals for newer technology not expected to generate a high volume of claims – Category I codes

• Would not consider review of bundles of existing services; would not consider high volume services currently reported with existing codes; may defer review of these services to the May 2016 CPT Meeting to fall into the CPT and MFS 2018 cycle

• It is also plausible that coding changes for high volume services could be adopted at the February 2016 CPT Meeting, but publication held until the CPT 2018 coding cycle, to allow for pilot testing or extensive surveys/data collection. CMS should also consider holding open the possibility of exceptions to publish in CPT 2017 and 2017 MFS if there is an urgent programmatic need and specialties concur that interim final recommendations are acceptable under this situation.

 

April 28-May 1, 2016 RUC Meeting

• Review of new CPT codes that describe new technology/techniques with expected low volume generated at the February 2016 CPT Meeting. These low volume services would be published in CPT 2017 and included in the 2017 MFS;

• RUC review of existing high volume services could be conducted, but recommendations would be considered in rulemaking for the 2018 MFS

 

May 2016

• RUC submits recommendations to CMS for ALL issues discussed at April 2016 RUC meeting.

 

July 2016

• CMS releases Proposed Rule for the 2017 MFS. The Proposed Rule would include the RUC recommendations (could include link to all documents related to RUC recommendations) and CMS consideration of these recommendations. These recommendations would relate to the submissions from November 2015 and early March 2016. CMS could refer to recommendations for low volume new technology codes (or other permitted code changes) by the RUC in May (also provide link) and note that CMS review of these codes would be published as interim in the November Final Rule;

• CPT codes published in the Proposed Rule would be the temporary codes (i.e., with xx numbering) as the actual CPT code numbers would not be released until August 31

 

November 2016

• CMS releases Final Rule for the 2017 MFS. CMS review of the RUC recommendations from May submission are included as interim and open for 60-day comment period. Note that the addition of these codes would not cause significant changes to practice expense computations as the expected volume would be low.