Speaking Up: ACCC Expresses Concerns in Comments to Proposed Rules

Posted in ACCC News, Advocacy, Healthcare Reform, In and Around Washington, DC by ACCCBuzz on September 11, 2013

By Matt Farber, MA, Director Provider Economics and Public Policy, ACCC

new_year_2014_shutterstock_117199060-300x216On Friday, September 6, ACCC formally submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the 2014 Physician Fee Schedule and the Hospital Outpatient Prospective Payment System proposed rules. ACCC has numerous concerns about proposals included in each of the rules, and the public comment period is an important opportunity to voice those concerns.  If CMS does not hear from organizations such as ACCC, the agency may believe that its proposals will not adversely impact community oncology.  Some of the key issues we focused on in our comments are outlined below.

Physician Fee Schedule.  In its comments, ACCC asked that CMS:

  • Work with Congress to develop a long-term fix to the Sustainable Growth Rate (SGR) formula and avert a 24.4 percent reduction to the conversion factor in 2014;
  • Work with ACCC to study the issue of payment for services rendered in off-campus hospital-based departments;
  • Apply adjustments to the work relative value units (RVUs) instead of the conversion factor to reflect changes in the Medicare Economic Index (MEI);
  • Exercise caution when reviewing codes it identifies as potentially misvalued;
  • Implement the proposal to create a new G-code for complex chronic care management services that meet certain standards; and
  • Not implement the proposed cap on PFS non-facility payments using facility rates calculated under the Hospital Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) payment systems.

ACCC has great concern about the proposal to cap the PFS payments using rates from the hospital outpatient department  or ambulatory surgical center settings. Our concern is that, for some codes, CMS is reducing payments based on procedures that are rarely given in certain sites of service. CMS also proposes to apply the cap when as little as five percent of the total volume of services are furnished in the hospital outpatient setting. Analysis of the proposed rates indicates that CMS often set the cap using ASC rates, even though the volume of services in that setting was far below five percent. This extremely low threshold does not help ensure that the capped rates accurately reflect typical costs for providing the service in either the physician office or facility setting. Further, when the Medicare Payment Advisory Commission (MedPAC) recommended that CMS cap certain hospital outpatient payments at the rates applicable in physician offices or ASCs, it recommended a threshold of 50 percent of claims in the setting used to establish the cap to ensure that payment rates are sufficient to protect access to care.  ACCC believes that CMS’s proposal is unnecessary, and we are asking the agency to provide justification for its choice of site of service for setting payments.

OPPS Proposed Rule. ACCC asks that CMS:

  • Implement the proposal to reimburse hospitals for the acquisition cost of separately payable drugs at ASP+ 6%;
  • Make separate payment for all drugs with HCPCS codes, or, at a minimum, not increase the packaging threshold for drugs;
  • Not implement the proposal to change the calculation for payment rates of computed tomography (CT) scans and magnetic resonance imaging (MRI);
  • Not implement the proposal to consolidate clinic and emergency department evaluation and management (E&M) codes from five levels to one level; and
  • Not implement the proposal to expand packaging for additional items and services until the agency corrects the significant errors and inconsistencies in the proposed rates, provides opportunity to comment on the corrections and clarifications, and reviews those comments.

In the 2014 proposed OPPS rule, CMS made some drastic moves to increase the amount of bundling in the hospital outpatient department. ACCC believes that the proposals will adversely impact cancer care. Of particular concern are proposals for the consolidation of E&M codes, changes to the calculation for payment rates of CT and MRI, and additional packaging of drug administration services. Added to these concerns is the fact that ACCC and other organizations believe there are significant errors in the proposed rates. We fear that these errors would further decrease reimbursement to critical areas of oncology care. Included with ACCC’s comments are memos from numerous experts that echo the same concerns about the validity of the data. The Hospital Payment Advisory Panel (HOP) agreed with ACCC and other stakeholders at its meeting last month, and recommended that CMS delay its proposals until the agency could verify these data. At a minimum, ACCC asks that CMS delay these proposals. Ultimately, however, it is our hope that CMS will listen to the stakeholders’ concerns and opt not to implement many of the packaging proposals.

We are reminded, once again, of the importance of public comments to these proposed rules. Unless ACCC and other organizations submit comments to CMS, these issues might never have come to light. If you are interested in learning more, or possibly submitting comments in the future, please contact me at

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