Member News
Dear RAI Members,

We would like to share the following important messages from the Coalition of State Rheumatology Organizations (CSRO).

If you are not already receiving CSRO bi-weekly updates, we encourage you to join their mailing list through the CSRO website.
CSRO Legislative Updates
On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released its CY 2023 Medicare Physician Fee Schedule (PFS) proposed rule, which includes key changes to the physician fee schedule (PFS) and other Medicare Part B payment policies, as well as proposed updates to the Quality Payment Program (QPP) and Medicare Shared Savings Program (MSSP). As part of CSRO’s community, we are providing a high-level overview of some key points for your reference. The full proposed rule can be read here. 
 
Of note, CMS estimates the CY 2023 PFS CF to be $33.0775, which reflects the 0.00% update specified in law, a budget neutrality adjustment and the expiration of the 3% increase for services furnished in CY 2022. Specific to rheumatology, estimated payment impacts on allowed charges based on the policies outlined in the rule can be found in Table 138 and Table 139. Keep in mind, the estimated impact tables linked here do not reflect the loss of the temporary, one-time payment update of 3% discussed above. Actual impacts will vary based on multiple factors, including practice size and services lines. 
 
CSRO will submit comments to CMS on the proposed rule before the deadline of September 6, 2022, which will be shared once available. The final rule is expected to be published on or about November 1, 2022.
A few highlights specific to rheumatology: 

  • Rebasing and Revising the MEI – CMS proposes to rebase and revise the Medicare Economic Index (MEI) cost share weights from a 2006-base year to a 2017-base year, but delay implementation for both PFS ratesetting and the proposed CY 2023 GPCIs. CMS notes that there would be significant shifts in specialty level payments if it were to use the proposed rebased and revised MEI cost share weights (i.e., specialties with relatively high practice expense (PE) costs would realize positive impacts, whereas specialties with higher physician work costs would realize negative impacts). CMS also believes it is critical for the public to have an opportunity to comment on the proposed rebased and revised MEI before it is incorporated into PFS ratesetting and the PE GPCIs. 
  • Updating PE Data Collection and Methodology – Stakeholders have raised concerns about CMS’ PE data collection and methodology. As an example, in CY 2022, CMS proposed and finalized the use of updated data for clinical labor wages. Of course, after not updating these data for 20 years, and operating in a budget neutral system, this wreaked havoc on several specialties and the services they provide, including drug administration. CMS agrees that it is necessary to establish a roadmap toward more routine PE updates and signals its intent to move to a standardized and routine approach to valuation of indirect PE, which will be included in future rulemaking. As part of this effort, CMS has contracted with RAND to develop and assess potential improvements in the current methodology used to allocate indirect practice costs in determining PE RVUs for a service, model alternative methodologies for determining PE RVUs, and identify and assess alternative data sources that CMS could use to regularly update indirect practice cost estimates. Considering the impact delayed updates to clinical labor pricing continues to have on drug administration services, it is important for CMS to make routine updates. 
  • Discarded drug rebates – CMS proposes implementation of section 90004 of the Infrastructure Investment and Jobs Act, which requires manufacturers to provide a refund to CMS for discarded amounts from certain single-dose container or single-use package drugs. With regard to Medicare providers who administer Part B drugs, since 2017, providers have been required to report the JW modifier on their Part B drug claims to indicate discarded amounts. However, many claims are still submitted without that modifier and CMS now needs that information to calculate the amount owed by the drug company. Thus, CMS will continue requiring the JW modifier for any discarded amount but, starting on January 1, 2023, CMS will also require a new JZ modifier if there were no discarded amounts. 
  • QPP
  • The updated 2023 category weights, per statute, are as follows: 30% quality; 30% cost; 15% improvement activities; 25% PI.
  • CMS will modify MVP development process to allow for a 30-day comment period for new candidate MVPs determined by CMS as “ready for feedback” prior to rulemaking; CMS will also host a public webinar for certain revisions to established MVPs.
  • CMS is modifying the Advancing Rheumatology Patient Care MVP.
  • Note that CSRO has previously asked CMS to update the improvement activities in the MVP. CMS agreed with our suggested improvements in the CY 2022 PFS Final Rule, but they didn’t incorporate those in this rulemaking. 
  • CMS proposes to maintain the MIPS performance threshold at 75 points for the 2023 performance year (as a reminder, there’s no exceptional performance bonus starting in 2023).
  • CMS propose to increase the data completeness threshold from 70% to 75% for the 2024 and 2025 performance periods. 
  • CMS proposes changes to Rheumatology Specialty Set, as shown on p. 1874 of the rule.  
RAI • 847 517 7225 • info@rheumiowa.org