OSHA Announces COVID-19 Safety Rule for Health Care Industry

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has announced it will issue an emergency temporary standard to protect healthcare workers from contracting coronavirus. The standard focuses on healthcare workers most likely to have contact with someone infected with the virus. OSHA announced the new standard alongside new general industry guidance, both of which are aligned with Centers for Disease Control and Prevention guidance.

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CMS Announcement on MIPS Cost Category

The following is a message from the American Medical Association:

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the 2020 MIPS Cost Performance Category will be reweighted to 0% of the final score even if eligible physicians or groups submitted 2020 data in other MIPS categories in light of the impact of the COVID-19 pandemic. For over a year, the AMA has been recommending that CMS zero out this category during the pandemic for several reasons, including concerns that decreases in patient visits and increases in the costs of caring for patients with COVID-19 could unfairly penalize physicians. We applaud CMS for holding physicians harmless from unfair evaluations in the MIPS Cost Performance Category as a result of the COVID-19 pandemic.

The AMA also strongly supports CMS’ decision to release the 2018 and 2019 cost measure benchmark files, which we will review closely to identify the target spending for those years, how the benchmarks capture any variations in spending, and whether the benchmarks are leading to fair and valid comparisons among physicians. Again, the AMA has been recommending to CMS for a while that the agency should publish the data.  In April, the AMA and 47 national medical specialty societies sent a letter urging CMS to immediately release the MIPS cost benchmarks to increase transparency in how the agency evaluates physician performance in the Cost Performance Category in MIPS and to allow physicians and other stakeholders to assess the measures for validity and opportunities to reduce spending. We anticipate this information will be informative for specialty societies that are engaged in the ongoing development of new episode-based cost measures and MIPS Value Pathways (MVPs).

AMA-sponsored study on physician experiences with MIPS

The following is a message from the American Medical Association:

The results of a study conducted by Weill Cornell Medicine that was sponsored by the AMA and the Physicians Foundation have now been published. Researchers conducted 30 in-depth, semi-structured interviews with physician leaders in small and medium internal medicine and general surgery practices and large multispecialty practices about their experiences participating in Medicare’s Merit-based Incentive Payment System (MIPS). An article published in the Journal of General Internal Medicine provides qualitative results of physicians’ experience with the program, while an article published in JAMA provides quantitative insights into the cost of participating in MIPS and MIPS APMs.

Among the interesting qualitative findings:

  • MIPS is viewed as a continuation of previous programs and a precursor of future programs;
  • Performance measures are more relevant to primary care practices than other specialties
  • Leaders are conflicted on whether the program improves patient care
  • Participation creates administrative burden, exacerbated by frequent programmatic changes
  • Incentives are small relative to the effort
  • External support for participation can be helpful

In terms of cost, researchers found:

  • Annual cost of participation is about $12,000 per physician
  • Annual time spent by clinicians and staff is about 200 hours per physician
  • Costs per physician were predictably higher for smaller practices and for APM participants

Radiation Oncology Policy Update, May 2021

ACRO Members: The May issue of the Radiation Oncology Policy Update is now available. Some of the topics in this issue include:

  • ACRO joins coalition of stakeholders urging lawmakers to support provider stability
  • President Biden releases FY 2022 budget proposals
  • President Biden signs sequester suspension bill into law
  • Broad coalition challenges CMS Medicare prior authorization growth
  • CMS issues new guidance enforcing price transparency rule
  • Study finds telehealth increases downstream care

Just log in to your member account from the Advocacy tab to view the full update.

AMA Seeks Feedback as Medicare Begins Advance Payment Recoupment

The Centers for Medicare and Medicaid Services (CMS) recently began automatic recoupment of COVID-19 Accelerated and Advance Payments, which were an advance of up to three months of Medicare payments to help physician practices keep the lights on early in the COVID-19 pandemic. The American Medical Association(AMA) and the Federation strongly advocated for improved repayment terms, which Congress and CMS adopted in 2020. Under the revised repayment terms, physicians should be aware that:

  • These funds are loans that are required to be repaid.
  • Repayment begins one year from when the Medicare advance payment is received, rather than 120 days under the original terms.
  • The per claim recoupment amount was reduced from 100% to 25% for the first 11 months, and then 50% for an additional six months.
  • If there is an outstanding balance after the 17-month recoupment time frame, the Medicare Administrative Contractor (MAC) will issue a demand letter requiring repayment subject to an interest rate of 4%, a decrease from the original interest rate of 10.25%.
  • Physicians may repay the Medicare advance payment in full at any time by contacting their MAC.

The AMA would like your feedback about recoupment of the Medicare advance payments. Please share your feedback by emailing AMA.Advocacy@ama-assn.org.

Congressional Action on the Medicare Sequester

On March 25, the Senate voted 90-2 to pass an agreement reached by Leaders Schumer and McConnell to extend the 2 percent Medicare sequester moratorium that expires on April 1. The bipartisan legislation, offered as an amendment by Senators Shaheen and Collins, would provide a nine-month extension of the moratorium, through December 31. It also contains some technical corrections related to rural health clinics and disproportionate share hospitals.

The House of Representatives passed different legislation earlier that would both extend the moratorium through the end of the pandemic and eliminate an additional 4 percent Medicare sequester scheduled to take effect on January 1, which was required by PayGo rules to offset part of the cost of passing the American Rescue Plan COVID-19/stimulus package. Consequently, the House will need to pass the Senate language when it returns from its Easter recess in mid-April. The House is expected to vote favorably, and the Centers for Medicare & Medicaid Services is expected to hold off on processing April claims until then to avoid making reduced payments.

Physician and other stakeholder groups affected by the upcoming 4% sequester scheduled for January 1 expect legislation to be considered later in the year to waive those cuts.

More from AMA

ACRO 2021 Luther Brady Lecture: BEAM ON! Shedding Light on Social Injustice, Race Relations, and Healthcare Disparities

Be part of a poignant, timely, and inspirational session led by world-renowned leaders in the field of Radiation Oncology. Drs. Iris Gibbs, Dwight Heron, Karen Winkfield, and Mack Roach III led an engaging discussion, entitled, “BEAM ON! Shedding Light on Social Injustice, Race Relations, and Healthcare Disparities,” which covered the history of social justice & its personal and professional impact, experiences of perseverance, audience engagement and a call to action as a community to continue the fight for equality.

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AMA report shows physician Medicare revenue down 19% over first half of 2020

The new report “Changes in Medicare Physician Spending During the COVID-19 Pandemic” analyzed Medicare claims data exclusive to physician services and found spending dropped as much as 57% below expected pre-pandemic levels in April of 2020. Medicare spending on physician services partially recovered from the April low but was still 12% less than expected by the end of June 2020. During the first half of 2020, the cumulative estimated reduction in Medicare physician spending associated with the pandemic was $9.4 billion (19%). The report also provides estimates by state and specialty.

The cumulative reduction in MPFS spending for radiation oncology was 8%.

AMA Correspondence on Medicare Sequester

The included letter was sent to leadership in the House and Senate regarding the upcoming expiration of the 2% Medicare sequester and the potential for an additional 4% sequester effective next January as a result of PAYGO rules that will go into effect following passage of the economic stimulus package currently under debate. Clearly, these Medicare payment cuts would be unsustainable for physician practices and ACRO will be advocating against such reductions.

CMS holds physicians harmless from MIPS penalties amid COVID-19 PHE

Today, CMS announced it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency on physician practices’ performance in 2020.

The Extreme and Uncontrollable Circumstances Hardship Exception policy will be automatically applied to ALL MIPS eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty. CMS is also reopening the hardship exception application for group practices, virtual groups, and alternative payment model entities who missed the previous 2020 deadline. The re-opened application deadline is March 31, 2021. Note, groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.

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