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

Bulletin Advocacy Brief: July 15

CMS Releases CY 2022 MPFS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) proposed rule on July 13. CMS proposes a CY 2022 conversion factor of $33.58, a decrease of $1.31 from last year's conversion factor. The cut to general surgery under the proposed rule will be -3.75 percent, but other Congressionally mandated cuts may affect the final general surgery payment change for 2022.

CMS proposes refinements to its policies for split (or shared) evaluation and management visits, which are visits provided in the facility setting by a physician and a non-physician practitioner (NPP) in the same group. For CY 2022, CMS would permit the practitioner—either the physician or NPP—who provided more than half of the total time spent on the visit to bill for the services furnished. CMS would also prohibit critical care visits from being reported during the same time period as a procedure with a global surgical period and would bundle payment for such visits with global surgery procedure codes.

In addition, CMS would allow certain services added to the Medicare telehealth list during the PHE to remain on the list through the end of CY 2023 to allow time for the Agency and stakeholders to evaluate whether the services should be permanently added to the telehealth list following the pandemic. CMS also proposes to implement a special coinsurance rule for colorectal cancer screening services that are planned as screening tests but become diagnostic tests when the physician identifies the need for additional treatment (such as removal of polyps). This proposal is intended to reduce beneficiary cost-sharing for diagnostic colorectal services.

The American College of Surgeons (ACS) is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its payment provisions. Contact lfoe@facs.org with questions.

ACS Strongly Opposes Proposed Cuts to Surgical Patient Care in Proposed 2022 MPFS Rule

The ACS strongly opposes the cuts to surgical care contained within the proposed CMS fee schedule and urges Congress to address systemic challenges to stop the annual reductions in patient care.

"Our patients deserve a health care system that invests in surgical care. CMS is taking notable strides to improve health equity; however, this proposal would achieve the opposite by threatening patient access to critical treatments and procedures," said ACS Executive Director David B. Hoyt, MD, FACS. "The ACS stands ready to work with Congress toward a sustainable, long-term solution in the interest of all patients."

The proposed rule from CMS maintains cuts to surgical care that Congress stopped last year. The Medicare conversion factor for CY 2022 will be cut by 3.75 percent under the CMS proposed fee schedule. The conversion factor is the basic starting point for calculating Medicare payments. Updates to the conversion factor have failed to keep up with inflation. The result is that the conversion factor is only about 50 percent of what it would have been if it had been indexed to general inflation as it had been prior to 1998. The proposed CMS rule further emphasizes the need for continued intervention by Congress to protect patient care.

The ACS is a founding member of the Surgical Care Coalition, which advocates for access to quality surgical care for all Americans. The Surgical Care Coalition is comprised of 13 surgical professional associations that proudly represent the more than 150,000 surgeons working across the country with a common goal of improving the quality of care, and quality of life, for all patients.

CMS Releases Proposed CY 2022 Quality Payment Program Updates  

On July 13, 2021, CMS released proposed updates for the CY 2022 Quality Payment Program (QPP) as part of the CY 2022 Medicare Physician Fee Schedule (MPFS) proposed rule. The rule outlines proposed changes to the two quality reporting pathways under the QPP—Merit-based Incentive Payment System (MIPS) and Alternative Payment Models. These updates include an increase of the overall MIPS threshold, adjustments to the Cost and Quality performance category weights, and the implementation of seven introductory MIPS Value Pathways (MVPs) beginning with the CY 2023 performance period. The rule also includes multiple requests for information to explore strategies to close the health equity gap in CMS clinician quality reporting programs and to transition to digital quality measurement.

The proposed implementation of MVPs is one of the major provisions in this year's proposed rule. MVPs were first introduced in the CY 2020 QPP proposed rule to streamline MIPS reporting by limiting the number of required measures to best assess the quality and value of care within a particular specialty or condition to allow for an easier transition to APMs. The implementation of MVPs was delayed to avoid unnecessary burden to physicians during the COVID-19 pandemic. Within this CY 2022 proposed rule, CMS proposes to move forward with MVPs beginning with the 2023 performance period.

The ACS is analyzing these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its QPP provisions. Contact qualityDC@facs.org with questions.

ACS Signs Coalition Letter in Support of HVIP Funding

The ACS, along with more than 30 national health care, medical, and public health organizations, signed a letter to Congressional appropriators urging funding for hospital-based violence intervention programs (HVIPs). HVIPs aim to help break the cycle of violence, including the nation's gun violence epidemic, by connecting patients at risk of experiencing or perpetrating violent injury with key hospital, community based, and case management services to prevent repeat injury and retaliatory violence.

There is currently no dedicated federal funding stream to support such effective programming. President Biden's fiscal year 2022 budget requests $100 million for the Centers for Disease Control and Prevention to implement intervention programs to address the causes of violence and reduce health inequities. The request is in addition to a proposal in the American Jobs Plan to invest $5 billion over eight years to support community violence intervention programs, including those in hospital settings.

The ACS has strongly supported enhancements to HVIPs, including supporting the Bipartisan Solution to Cyclical Violence Act (H.R. 1260), which would provide grant funding to create new hospital-based violence intervention programs, expand current successful programs, and require research on best practices. H.R. 1260 passed in the U.S. House of Representatives in May.

For more information, contact Amelia Suermann, asuermann@facs.org.

Want to Learn More about General Surgery Coding? Register for Live ACS Surgical Coding Course

The ACS is offering a live surgical procedure coding course that covers everything important in general surgery coding, packed into an intensive six and one-half hours. The agenda covers all you need to know to code and document accurately and efficiently. The course provides in-depth and interesting instruction on coding for endoscopy, colorectal, breast, hernia, appendix, gall bladder, liver, intraabdominal tumor, pancreatic, and endocrine procedures. The course also will cover ways to improve notes and the use of surgical payment modifiers, leaving attendees armed with ideas and techniques for setting up systems that reduce denials and increase successful appeals.

The General Surgery coding courses will span two days and three courses—two half-day sessions focused on E/M and office procedure coding and one full-day session focused on surgical coding. The dates and locations for the courses are as follows:

For more information about the 2021 ACS coding courses, visit the ACS website or e-mail practicemanagement@facs.org.

Register for Live E/M Coding Courses and Be Up to Date on Latest Guidelines

Starting January 1, 2021, two sets of guidelines came into play for E/M (evaluation and management) coding—one for new and established office/outpatient visits, and one for all other E/M encounters. To help clarify the guidelines, the ACS is offering live E/M coding courses later this year. One of the half-day E/M courses will focus on what determines code selection, including updated rules for using time and significant changes in the table for risk related to the decision for surgery. The second half-day course will continue discussing these critical updates to Medicare but expand on telehealth coding and cover coding for office-based procedures that general surgeons perform, such as biopsies, skin excisions, debridement, and more.

The General Surgery coding courses will span two days and three courses—two half-day sessions focused on E/M and office procedure coding and one full-day session focused on surgical coding. The dates and locations currently available for the courses are as follows:

For more information about the 2021 ACS coding courses, visit the ACS website or e-mail practicemanagement@facs.org.