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AMA Urges CMS to Better Align MU, Other Federal Programs

October 27, 2014
by Rajiv Leventhal
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The American Medical Association (AMA) has sent a letter to the Centers for Medicare and Medicaid Services (CMS) urging the agency to align federal regulations such as the meaningful use program, the physician quality reporting system (PQRS), and the value-based modifier program (VBM).

"Physicians want to provide our patients with the best care possible, but today there are confusing, misaligned and burdensome regulatory programs that take away critical time physicians could be spending to provide high quality care for their patients," American Medical Association President Robert M. Wah said in the letter. "These complicated overlapping requirements make it difficult for physicians to invest in health information technology and payment and delivery reforms that are believed necessary to improve care for patients. Government leaders should take the necessary steps to eliminate this regulatory nightmare and ensure America's seniors can continue to receive the high quality care they deserve."

AMA warned CMS about the “regulatory tsunami” facing America's physicians that could cut Medicare reimbursements by more than 13 percent by the end of the decade. The cuts include a number of “overlapping and often conflicting patchworks of laws and regulations,” such as the abovementioned ones, AMA said. “These cuts would pile on top of the potential 21 percent reduction that physicians could face if the flawed sustainable growth rate (SGR) formula is not permanently repealed and replaced,” the letter stated.

According to AMA, the lack of alignment between the MU, PQRS and VBM programs forces physicians to register and report their information multiple times in a variety of formats that is not only time consuming but creates wide-spread confusion. In addition, the numerous and varied requirements, the different scheduled phase-ins and annual changes in requirements for each program make compliance overwhelmingly difficult. AMA is urging CMS to simplify and synchronize MU, PQRS and VBM.

The AMA says that it is advocating for a streamlined process that would allow physicians to report once rather than multiple times and ways to meet and satisfy requirements for all of Medicare's physician quality programs. Additionally, the AMA believes further study is needed to ensure the current programs are staying true to their intents to create improvements in care and greater efficiencies.

"If physicians meet the protocol and standards for one quality program, they should be deemed successful for all," said Dr. Wah. "In its current state, the meaningful use program is just not meaningful and the large number of stringent regulatory requirements has taken away focus from the goals of the program, which is to allow for smooth information sharing across interoperable systems and put more decision-making tools in the hands of physicians at the point of care to improve quality. Additionally, the value-based modifier program is not creating value because the current methodology is flawed and adversely affects physicians who treat Medicare's poorest and sickest patients."

In order to address concerns about MU, PQRS and VBM, the AMA is recommending that CMS:

  •  Remove its all-or-nothing approach to meaningful use, make optional the measures that have been the most challenging for the vast majority of physicians and in many cases are outside of physicians' control, shorten the reporting period for 2015 to 90 days, and reduce burdensome certification requirements that are stifling EHR usability and innovation.
  • Release aggregate 2013 PQRS and VBM data that will allow physicians and the public to evaluate the programs in a more timely fashion, create a formal appeals process to give physicians more than 30 days to seek correction of any inaccurate information, and maintain a more robust set of claims-based measures and claims reporting options to reduce physician reporting costs.
  • Limit the implementation of the VBM if Congress and the administration are still determined to impose it on all physicians. If VBM is not repealed, CMS should at least provide more time to gauge its results on large physician groups before penalties are ratcheted up and extended to small and singular-owned practices.

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