Dear Acting Administrator Slavitt:
The undersigned national medical organizations strongly recommend that the Centers for Medicare and
Medicaid Services (CMS) restore the Refinement Panel to serve as the relative value appeals process that
was appropriately in place prior to 2011. The American Medical Association (AMA) reviewed the need
for an appeals process at the 2016 AMA House of Delegates Annual Meeting and determined that having
an objective, transparent and consistently-applied formal appeals process in place is paramount and that
the original Refinement Panel process would best serve this function.
For more than 25 years, CMS has convened the Refinement Panel to carefully review public comments,
hear testimony from practicing physicians and independently recommend refinements to relative values.
Until recently, the Refinement Panel conclusions were uniformly implemented by the Agency, as shown
in the attached table entitled, Attachment A: History of the CMS Refinement Panel. This historical
information provides evidence that CMS did rely upon the Refinement Panel as an appeals process.
In 2011, CMS modified the process to only consider appeals which include “new clinical information.”
Additionally, the Agency began to independently review each of the Refinement Panel decisions when
determining which values to actually finalize. Since the implementation of these changes, CMS has
rejected the majority of requests for Refinement Panel review and only accepted 36 percent of
recommendations from the Panel. With the dysfunctionality of the current iteration of the Refinement
Panel process, CMS no longer relies upon outside stakeholders to provide accountability. Absent any
independent mechanism for appeal, CMS officials are free to make valuation decisions without having to
provide a compelling rationale when rejecting relative value recommendations from the RUC and other
stakeholders.
…
Read full letter here
