Andy Slavitt, Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1631-P
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201
Re: Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other
Revisions to Part B for CY 2016
Dear Mr. Slavitt,
The Alliance of Specialty Medicine (the “Alliance”) represents more than 100,000 specialty physicians from 14
specialty and subspecialty societies. Our mission is to advocate for sound federal health care policy that fosters
patient access to the highest quality specialty care. In line with our mission, we provide the following comments
on the CY2016 Medicare Physician Fee Schedule Proposed Rule.
Determination of Malpractice Relative Value Units
The Alliance is concerned that the impact of CMS changes regarding professional liability insurance (PLI) is
estimated by CMS to have a negative impact on some specialties. We understand that CMS has said that the
decrease “relates to a technical improvement that refines the MP RVU methodology, which we are proposing to
make as part of our annual update of malpractice RVUs. This technical improvement will result in small negative
impacts to the portion of PFS payments attributable to malpractice for gastroenterology, colon and rectal
surgery, and neurosurgery.” However, we would like to see more details on how the specialty impacts were
determined. We appreciate the assertion that it may be difficult to obtain premium data for some specialties,
however, we believe the agency must thoroughly vet the methodology used by the contractor. We urge CMS to
review the data, continue to try to obtain updated premium data in as many states as possible, and to share the
data in the final rule in order for the agency and the specialty to determine its accuracy.
Potentially Misvalued Services Under the PFS
The Alliance continues to have concerns about CMS’ implementation of the potentially misvalued code initiative.
Most notably, we are concerned that many of CMS’ screens are based simply on utilization, and that CMS does
not consider the quality and value of these services. We urge CMS to seek advice from the American Medical
Association (AMA) Relative Value Scale Update Committee (RUC) to refine its potentially misvalued code
initiative.
Review of High Expenditure Services across Specialties with Medicare Allowed Charges of
$10,000,000 or More
We continue to believe that the application of the “high expenditure by specialty” screen, which identifies codes
that account for greater than $10M in Medicare expenditures within a specialty, is arbitrary and flawed. As the
agency is aware, the $10M threshold does not take into account the value of services being provided, nor does it
consider other circumstances for why expenditures have reached this level of spending. In many instances,
increased levels of utilization and higher spending are directly attributed to a specialty’s response to evolving
practice guidelines, appropriate use criteria, and current medical literature, not to mention the sharp increases
in the number of beneficiaries becoming eligible for Medicare each year. Furthermore, CMS has consistently
failed to take into account local and national coverage decisions and other payment and coverage policies that
may lead to services reaching the $10M threshold. Finally, we request that CMS remove ZZZ codes from the
screen as they are add-on codes to 10- and 90-day global procedure codes that have been excluded from the
review. We urge CMS to revise this screen under the statutory category, “codes that account for the majority of
spending under the PFS.”
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Read full letter here.
