Premier Comments on CY 2024 Physician Fee Schedule/Medicare Shared Savings Program Proposed Rule

Premier submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the CY 2024 Physician Fee Schedule (PFS) proposed rule.

Premier leveraged its years of experience working with more than 200 accountable care organizations (ACOs) to make recommendations on CMS’ proposed changes to the Medicare Shared Savings Program (MSSP). Specifically, Premier urges CMS to:

• Establish a more adequate transition to the new MSSP quality reporting requirements, including ensuring requirements are consistent with CMS’ digital quality measurement strategy, developing ACO-specific measures and piloting requirements prior to broad adoption;
• Revise eligibility to make the MSSP health equity adjustment available to all ACOs regardless of their selected quality reporting mechanism;
• Exclude in the final rule its proposal to align MSSP with the Merit-Based Incentive Payment System (MIPS) by requiring clinicians participating in an ACO, regardless of track, to meet and report the MIPS Promoting Interoperability (PI) performance category requirements;
• Adopt its proposal to modify MSSP risk adjustment methodology to ensure that both benchmark and performance years reflect the transition to the new risk adjustment model for ACOs starting new agreement periods in 2024, as well as to allow ACOs that started an agreement period prior to 2024 the option to transition to the new model sooner;
• Utilize MSSP as an innovation platform and scale best practices, including incorporating a higher risk track within MSSP and testing a primary care capitation option; and
• Eliminate the arbitrary high-low revenue distinction in MSSP.

Premier also provided comments on new Medicare PFS policies that CMS has proposed, urging the agency to:

• Finalize proposals to add new billing codes for caregiver training and services associated with social determinants of health, while considering additional ways to better align data collection requirements and reimbursement across Medicare payment systems;
• Finalize proposed telehealth flexibilities and continue to expand Medicare coverage and payment for all types of virtual services involving communications technologies including telehealth, online visits and audio visits;
• Finalize behavioral health payment proposals and continue to examine whether additional behavioral health provider types could appropriately provide Medicare benefits to beneficiaries, further expanding access and alleviating critical workforce shortages;
• Finalize a split/shared visit policy that provides an alternative method for determining substantive portion of the visit based on either history of present illness, physical exam or other criteria consistent with prior guidance;
• Work with third-party technology vendors and Congress to help operationalize the Appropriate Use Criteria program and ensure compliance with statutory requirements; and
• Adopt a revised policy to calculate Qualifying APM Participant (QP) determinations at both the APM entity and individual clinician level and award QP status based on the higher score.