ASCP Pushes CMS to Improve PFS QPP Rule for Pathologists

Publication Date: Nov 12, 2019

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies Final Rule, which includes provisions around the Quality Payment Program (QPP). ASCP is pleased that CMS incorporated a number of our advocacy recommendations. ASCP is still reviewing the rule, but the following presents a high-level summary of the QPP policies finalized for 2020.

Under the QPP, performance in 2020 will affect physician payments in 2022, with a +/- 9% payment adjustment based on performance. CMS maintained most policies from the 2019 Final Rule (low-volume threshold, opt-in policy, and definitions around non-patient facing clinicians), with the following specific policies excepted:

MIPS Policies

Quality Measures

CMS proposed to eliminate 21 percent of the existing quality measures, but, importantly, it did not finalize the removal of the pathology measures set as originally proposed even though these measures are extremely topped out. ASCP urged CMS not to remove these measures because there are few measures available for non-patient facing clinicians, such as pathologists. CMS did finalize a proposal to remove measures that do not meet case minimum or volumes required for benchmarking for two consecutive years.

Improvement Activities Performance Category

CMS finalized its proposal to increase the participation threshold for the Improvement Activities category from a single clinician to 50 percent of the clinicians in the practice. The finalized policy differs from the proposal in that it allows clinicians to perform the activity during any consecutive 90-day period during the performance year (i.e., everyone does not need to perform the activity at the same time).

Increased Data Completeness Threshold and Point Levels

To help ensure pathologist reporting compliance, ASCP recommended that CMS not increase its data completeness threshold. The Agency, however, moved forward with its proposal to do so for quality measures from 60 percent in 2019 to 70 percent in 2020. As a result, clinicians or groups that do not meet this threshold will receive zero points on their applicable measures unless they are in a small practice (15 or fewer clinicians). CMS also increased the number of points needed to avoid a penalty from 30 points in 2019 to 45 points in 2020 despite ASCP’s opposition to the proposal. ASCP cautioned the Agency that increasing the points threshold will unfairly disadvantage pathologists due to the limited number of available quality measures. As a result, successful participants will have to score above the 45-point threshold to receive positive payment adjustments in 2022. CMS also raised the point threshold for the exceptional performance bonus to 85 points.

Performance Category Weights

For non-patient facing providers, the Cost and Promoting Interoperability categories are not applicable, so pathologists’ performance is based on the Quality and Improvement Activities performance categories. The weighting for the Quality category will remain at 85 percent and the Improvement Activities category will remain at 15 percent for non-patient facing clinicians. Because of the heavy weighting of the Quality category, ASCP advocated for more meaningful participation in all performance categories for pathologists, as well as a more evenly distributed re-weighting process. ASCP will continue to advocate for these changes in future years of the MIPS program.

MIPS Value Pathways (MVPs)

CMS’ intent with the MVP approach is to streamline reporting, reduce physician burden and focus on measures tailored toward an episode of care or condition rather than the current piecemeal reporting requirements. While these goals are laudable, ASCP expressed concern in our comments on the proposed rule that the MVPs don’t necessarily factor in specialties and non-patient facing providers. For example, the bedrock of the new framework is the Promoting Interoperability category, which pathologists are exempt from due to their use of LIS vs. traditional EHRs.

While CMS did not provide any specifics on the framework in the Final Rule, it emphasized that it is developing the MVP to reduce burden on physicians and that they plan to work with specialty societies to develop a comprehensive and relevant approach that relates to specialists’ real-world work streams, specific episodes of care they provide, and patient populations.

ASCP will continue to work with CMS to ensure the MVPs meaningfully incorporate non-patient facing providers, such as pathologists, and incentivize them to participate in the new framework.

Alternative Payment Models (APMs)

CMS also finalized proposed changes to the Advanced APM track for 2020, including changing the “expected expenditures” definition. Changing this definition will impact financial risk calculations under both Advanced APMs and Other Payer Advanced APMs. CMS agreed to not increase the financial risk requirement for APMs for at least the next six years.

ASCP advocated that APMs and Advanced APMs should be tailored to participation by a wide variety of providers and that these APMs allow for opportunities for meaningful participation by pathologists and other non-patient facing clinicians to incentivize innovation and quality.

Other articles in the November 2019 ePolicy News:

ASCP and the BOC Advocate for Better CLIA Personnel Standards
ASCP Scores Major Victory with CMS on Laboratory Date of Service Policy
Medicare Physician Fee Schedule Rule Mixed, But Trouble Lies Ahead
Concerns About NGS Coverage Resonate with CMS
ASCP Continues Patient Advocacy Efforts on Surprise Billing Legislation
CMS Fails to Close Pathology Loophole in Self-Referral Rules

To read more articles from ePolicy News click here.

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

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