ASRA Comments on CMS’s 2018 Proposed Rule

Aug 21, 2017

ASRA submitted a 12-page, 14-point letter of feedback and recommendations to the Centers for Medicare & Medicaid Services today, in response to the organization's request for feedback on the proposed rule "Medicare Program; Updates to the Quality Payment Program" (CMS-5522-P). The rule, which will affect 2018 and beyond, was developed to increase flexibility and reduce burden associated with Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015. 

ASRA supports a number of the proposed rule components but also opposes some aspects and provides several recommendations for improvement. Specifically, ASRA supports:

  • The low-volume threshold, the small practice bonus, the 3-point floor for small practices on quality measures, and the significant hardship exception in the advancing care information (ACI) performance category for small practices.
  • The "Pick Your Pace" strategy for the first year of the Quality Payment Program.
  • The stratification of benchmarks for quality measures by specialty until the development of specialty-specific quality measures.
  • Weighting of the cost performance category to zero in 2018, with the caveat that CMS provide explanation to providers about how their individual performance scores would hypothetically impact their total MIPS scare and associated payment adjustment and provide specific feedback to improve performance in this category for future years.
  • Not incorporating cost improvement into the MIPS cost performance score for 2018. However, ASRA strongly opposes CMS's proposal to incorporate improvement into the MIPS cost performance category as it disadvantages clinicians already providing efficient care.
  • The proposed hardship exception for hospital-based clinicians in off-campus outpatient hospitals, ambulatory surgical center- (ASC-) based clinicians, clinicians using decertified certified electronic health record technology, and small practices.
  • CMS's proposed 15-point performance threshold for 2018, which would allow clinicians to transition into the program. ASRA recommends that CMS provide the public with detailed data on MIPS performance before determining whether mean or median performance is the most appropriate method for setting the total performance threshold.
  • Incorporation of beneficiary social risk factors such as through the proposed complex patient bonus, which ASRA recommends be raised, and through risk adjusting specific quality and cost measures.
  • Voluntary, facility-based measurement for applicable clinicians, with expansion to include anesthesiologists practicing in hospital outpatient and ASC-based settings.

ASRA strongly opposes incorporating improvement into the MIPS quality performance score as it could disadvantage clinicians who already provide high-quality care and does not provide incentives or reward clinicians for the high-quality care they are already providing.

ASRA also noted agreement with the American Society of Anesthesiologists' (ASA's) recommendation to substitute a score with a 50% base and the clinician's/group's quality score for MIPS-eligible clinicians or groups that do not have an ACI score.

ASRA specifically recommends an increase to the complex patient bonus given the evidence that clinicians treating a disproportionate amount of beneficiaries with social risk factors do not perform as well in Medicare value-based payment programs – even after accounting for patient mix. ASRA recommends that CMS use the Medicare Advantage Hierarchical Conditions Categories as a basis for this bonus.

Read the entire letter here.

Read the proposed rule here.


Read more about ASRA's advocacy efforts.

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