The California Medical Association (CMA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) commenting on the proposed rules that would impact many aspects of physician payment and federal regulatory programs for 2015.

The 39-page letter strongly opposes the agency's plan to accelerate the implementation of the value-based modifier (VBM) payment methodology. CMS has said it will expand the VBM to all physicians in 2017 and increase the potential penalty from 2 percent to 4 percent.

CMA also argued that because the agency is ignoring the law that requires CMS to adjust the payment rates for the socioeconomic characteristics of the patients the VBM could discourage physicians from accepting the sickest and poorest patients. The value modifier was enacted by Congress as part of the Affordable Care Act (ACA). A CMA amendment to the law required CMS to risk-adjust the rates, adjust for California’s higher geographic practice costs and certain socioeconomic factors. The VBM is supposed to pay physicians more if they spend less than the national average per patient and successfully report on quality measures. It pays physicians less if they spend more than the national average and do not report on quality.

CMA also urged the agency to make revisions to the practice expense relative value units and improvements to the valuation and coding of the global service package. The letter also calls upon CMS to allow physicians to opt-out of Medicare indefinitely rather than every two years, to take CME reporting out of the Physician Payment Sunshine Act, and to scale back the Physician Compare Website until the accuracy of the information can be verified.

CMS has also proposed increasing from 3 to 9 the number of quality measures that physicians must report in order to avoid a 2 percent payment penalty under the Physician Quality Reporting System). CMA and AMA oppose the quality measure increase and have asked CMS to stabilize the quality measures so they are not changed on a yearly basis.

CMA applauded the expansion of payment for telemedicine services and payment for non-face-to-face visits for managing the care of the chronically ill.

More than 2,000 comments were received on the 600-plus-page proposed rule. A final version is expected to be released by Nov. 1. 

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmadocs.org.