Radiologists and other docs label 2022 Medicare Physician Fee Schedule a ‘mixed bag’

Radiologists and other docs see a “mixed bag” in the proposed 2022 Medicare Physician Fee Schedule that just dropped Tuesday.

The Centers for Medicare & Medicaid Services said its aim is to address gaps in health equity that only widened during the COVID-19 pandemic. Changes would include expanding access to telehealth services, enhancing diabetes prevention and improving quality programs.

In an analysis shared Tuesday night, the American College of Radiology said it’s “pleased” CMS plans to move forward with appropriate-use criteria in advanced diagnostic imaging. The program was mandated under the Patient Access to Medicare Act of 2014, and the agency is slated to launch the penalty phase on Jan. 1, 2023, or the first year following the end of the public health emergency.

“CMS recognizes the significant hardships faced by hospitals and medical practices during the pandemic as well as the investment that many practices have already made in [appropriate use criteria] systems,” ACR said in its July 13 analysis. “When fully implemented, the AUC program will be a valuable tool to ensure that Medicare patients receive the right imaging at the right time.”

The rule includes several fixes for claims-processing issues, which the college said have delayed the program’s implementation. ACR called such solutions “a step in the right direction,” but has plans for further review before issuing a more detailed response.

The Medical Group Management Association said it’s also “pleased” CMS opted to pause the punitive phase of AUC originally set to begin in 2022. This will give physician practices ample time to prepare, said Anders Gilberg, senior VP of government affairs. However, the association—which represents 55,000 practice leaders across the U.S., in radiology and other specialties—sees a “mixed bag” for physician practices in other parts of the proposal. Gilberg and colleagues are “concerned” about the potential impact of a proposed 3.75% reduction in the conversion factor due to budget neutrality and plan to seek congressional intervention to avert the cut.

CMS estimated a 2022 conversion factor of $33.5848 compared to $34.8931 in 2021. This would amount to a 2% decrease in radiology, ACR noted, and the same drop in nuclear medicine and radiation oncology. Interventional radiology, meanwhile, would sustain an aggregate drop of 9%.

“If Congress does not intervene, the percent decreases mentioned above could be greater for CY 2022 for many physicians including interventional radiology and radiation oncology,” ACR noted.

CMS also plans to revise its Quality Payment Program aimed at pushing providers toward value through a combo of financial incentives and penalties. In particular, it will require clinicians to meet a higher performance threshold to be eligible for bonus payments.

You can find more about the proposed QPP changes and other details in this CMS press release, fact sheet and in the Federal Register.

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