Skip To Navigation Skip To Content Skip To Footer
    Advocacy Letter
    Home > Press Statements & Advocacy Letters > Advocacy Letters
    March 31, 2017

    Seema Verma
    Centers for Medicare & Medicaid Services
    Department of Health and Human Services
    Hubert H. Humphrey Building, Room 445-G
    200 Independence Avenue, SW
    Washington, DC 20201

    Dear Administrator Verma:

    The undersigned physician organizations welcome the Trump Administration’s emphasis on reducing regulatory burdens. Congress recognized when it passed the Medicare Access and CHIP Reauthorization Act (MACRA) in an overwhelming bipartisan vote that the existing Medicare value-based purchasing programs affecting physicians—Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-based payment modifier (VM–needed to be streamlined and aligned. As the Centers for Medicare & Medicaid Services (CMS) implemented MACRA through the Quality Payment Program (QPP), we were grateful the agency recognized there were a number of challenges with the requirements of MU, PQRS, and VM. Consequently, we urge the Administration to take a series of steps to address these same challenges in MU, PQRS, and VM prior to their replacement by MACRA and minimize the penalties assessed for physicians who tried to participate in these programs. Clearly this would send a strong message to the physician community about the extensive regulations with which physicians have been dealing and the Administration’s commitment to reduce the burden.

    As directed by the 21st Century Cures Act, CMS must establish a strategy to relieve the electronic health record (EHR) documentation burden. To fulfill this legislative directive, we urge CMS to establish a new “Administrative Burden” category of hardship exemption for the 2016 MU performance year. Eligible providers should not be penalized for focusing on providing quality patient care rather than the arbitrary “check the box” requirements of MU. Creating an administrative burden hardship exemption would provide immediate relief for those impacted by the programs that predate MACRA.

    We also urge CMS to create a hardship exemption for physicians who attempted to report PQRS in 2016 but were unsuccessful due to the complexity of the reporting requirements and the significant number of measures that were required. The AMA has heard from many physicians who tried to successfully report PQRS 2016, but were unable to find nine measures that were applicable and meaningful for their specialty. Physicians also reported difficulties with the requirements that one measure had to be a cross-cutting measure, and the nine measures had to cover three National Quality Strategy Domains. Therefore, we recommend that CMS create a hardship exemption that would allow physicians who successfully reported on any number of PQRS measures in 2016 to avoid the two percent penalty in 2018.

    CMS recognized the difficulty of the reporting requirements and lack of applicable measures by reducing the requirements in the QPP to six measures and eliminating the domain and crosscutting measure requirements.

    In addition, CMS should take a number of steps to protect physicians from additional penalties of up to four percent under the VM. As a starting point, any physician who avoided the PQRS penalty in 2018 should be exempt from any VM penalties as well. These physicians would then all be eligible to participate in a voluntary quality-tiering program where positive, negative, or neutral payment adjustments would be distributed based on a comparison of performance on the applicable VM cost and quality measures for all tiering-eligible physicians, including those who chose not to enter the tiering process. In other words, physicians who met the nine-measure PQRS submission requirements or were eligible for a PQRS hardship exemption would not be penalized under the VM unless they voluntarily chose to compete and then scored poorly in the tiering process. Payment adjustments would be budget neutral, with bonuses for high performers financed by penalties for those who did not attempt to participate in PQRS or performed poorly in the tiering process. Practices of all sizes would receive a performance feedback report so that they could gain a better understanding of Medicare cost and quality measures and identify areas where their performance could be improved.

    As indicated in the MACRA law and final regulations, policymakers in Congress and the Administration clearly understand that fair and accurate measurement of physicians’ performance will not be possible until better tools become available. We are extremely appreciative of the efforts CMS has made to recognize and compensate for methodological shortcomings in MU, PQRS, and VM. We believe that the policies outlined above are consistent with the direction CMS is taking as we go forward with MACRA. We also believe the steps we have outlined are in keeping with President Trump’s efforts to reduce regulatory burden. We recognize that there might be other ways to achieve the same goal. We are open to discussing other options.

    American Medical Association
    Advocacy Council of the ACAAI
    American Academy of Allergy, Asthma & Immunology
    American Academy of Family Physicians
    American Academy of Hospice and Palliative Medicine
    American Academy of Neurology
    American Academy of Otolaryngology-Head and Neck Surgery
    American Academy of Physical Medicine and Rehabilitation
    American Association of Hip and Knee Surgeons
    American Association of Neurological Surgeons
    American Association of Neuromuscular & Electrodiagnostic Medicine
    American College of Allergy, Asthma and Immunology
    American College of Emergency Physicians
    American College of Gastroenterology
    American College of Mohs Surgery
    American College of Physicians
    American College of Rheumatology
    American College of Surgeons
    American Congress of Obstetricians and Gynecologists
    American Gastroenterological Association
    American Osteopathic Association
    American Psychiatric Association
    American Society for Radiation Oncology
    American Society for Surgery of the Hand
    American Society of Anesthesiologists
    American Society of Cataract and Refractive Surgery
    American Society of Clinical Oncology
    American Society of Dermatopathology
    American Society of Neuroradiology
    American Society of Plastic Surgeons
    American Society of Retina Specialists
    American Society of Transplant Surgeons
    American Urological Association
    Congress of Neurological Surgeons Endocrine Society
    Medical Group Management Association
    North American Spine Society
    Obesity Medicine Association
    Renal Physicians Association
    Society for Cardiovascular Angiography and Interventions
    Society of Critical Care Medicine
    Society of Hospital Medicine
    The Society of Thoracic Surgeons
    Medical Association of the State of Alabama
    Alaska State Medical Association
    Arizona Medical Association
    Arkansas Medical Society
    California Medical Association
    Colorado Medical Society
    Connecticut State Medical Society
    Medical Society of Delaware
    Medical Society of the District of Columbia
    Florida Medical Association Inc
    Medical Association of Georgia Hawaii Medical Association
    Idaho Medical Association
    Illinois State Medical Society
    Iowa Medical Society
    Kentucky Medical Association
    Louisiana State Medical Society
    Maine Medical Association
    MedChi, The Maryland State Medical Society
    Massachusetts Medical Society
    Michigan State Medical Society
    Minnesota Medical Association
    Mississippi State Medical Association
    Missouri State Medical Association
    Montana Medical Association
    Nebraska Medical Association
    Nevada State Medical Association
    New Hampshire Medical Society
    New Mexico Medical Society
    Medical Society of the State of New York
    North Carolina Medical Society
    North Dakota Medical Association
    Ohio State Medical Association
    Oklahoma State Medical Association
    Oregon Medical Association
    Pennsylvania Medical Society
    Rhode Island Medical Society
    South Dakota State Medical Association
    Tennessee Medical Association
    Texas Medical Association
    Vermont Medical Society
    Medical Society of Virginia
    Wisconsin Medical Society
    Wyoming Medical Society

    Explore Related Content

    More Advocacy Letters

    Explore Related Topics

    Ask MGMA
    Reload 🗙