ASA Opposes Finalization of Duplicative, Unnecessary Evaluation and Management Code, G2211, in Response to CMS's Medicare Physician Fee Schedule and the Quality Payment Program Proposed Rule

Today, ASA submitted comments to the Centers for Medicare & Medicaid Services (CMS) opposing significant payment cuts to anesthesiologists while providing comprehensive and detailed solutions on a wide range of issues surrounding physician payment and the agency’s quality programs. Absent Congressional action, physicians are facing a more than 5% payment cut in CY 2024 when considering the negative update to the Anesthesia and RBRVS CFs (3.26% and 3.36% respectively) and the continued Medicare Sequestration (2%). ASA finds CMS’ proposed adoption of the Healthcare Common Procedure Coding System (HCPCS) add-on code G2211 for office/outpatient evaluation and management as a driving force behind these payment cuts.

The proposed rule highlighted how the Medicare payment system is broken and constrained by policies that consistently cause negative impacts on physician practices and clinical payment outcomes. In our comments, ASA urged CMS to use any methods within the agency’s authority to modify budget neutrality adjustments and calculate more balanced conversion factors while working with Congress to identify more permanent solutions on this issue. ASA continues to advocate for legislative stakeholders and regulatory agencies to minimize and reverse these cuts that negatively impact anesthesiologists.

ASA’s letter expressed our support for updating indirect practice expense data more frequently to reflect current costs associated with running a practice and removing frequency limitations for two critical care consultation service HCPCS codes. However, the letter asked CMS to reconsider weights of the Medicare Economic Index that would reduce the physician work component.

On the Quality Payment Program section of the rule, ASA opposed a proposal to increase the Merit-based Incentive Payment System (MIPS) penalty threshold from 75 points to 82 points, as this policy would result in over half MIPS participants incurring a penalty and disadvantage specialties like anesthesiology. ASA also urged CMS to reconsider the proposed increase of the MIPS data completeness threshold from 75% to 80% starting in the CY 2027 performance period, as the policy fails to account for physician and group reporting burdens, as well as the resource-limited anesthesia groups that use paper records. ASA encouraged CMS to build off the current measures within the Anesthesia MIPS Value Pathway and finalize ABG44: Low Flow Inhalational General Anesthesia and

EPREOP31: Intraoperative Hypotension among Non-Emergent Noncardiac Surgical Cases in the 2024 anesthesia MVP.

ASA’s other QPP comments described how CMS’s MIPS topped out status policy undermines participation and program fairness. ASA also expressed our growing fears that the Total Per Capital Cost (TPCC) measure is being misapplied to anesthesia groups. Regarding Advanced Alternative Payment Models (APMs), ASA opposed the proposed requirement that all APM participants use certified electronic health record technology (CEHRT) criteria, due to the number of practices that do not have access to EHRs or rely on paper records.

Final regulations will likely be issued in November, and unless otherwise noted, policies will be effective January 1, 2024.

Read ASA comments here.

For more information on the Quality Payment Program, please contact the ASA Department of Quality and Regulatory Affairs (QRA) at [email protected].

More resources:

• ASA Washington Alert on 2023 proposed rule
• Proposed rule (PDF)
• Medicare PFS Proposed Rule fact sheet
• QPP fact sheet