On September 16, 2016, approximately 112 congressional representatives submitted a letter to HHS Secretary Sylvia Matthews Burwell and CMS acting Administrator Andy Slavitt requesting that CMS not implement its proposal regarding surgeon time data collection. 

The proposal at issue was released by CMS in its 2017 Physician Fee Schedule Proposed Rule, published on July 15, 2016.  By way of background, under the misvalued code initiative in the 2015 Physician Fee Schedule Final Rule, CMS finalized a policy to transform all 10- and 90-day global codes to 0-day global codes, beginning in calendar year 2018.  Pursuant to this policy, CMS would have valued the surgery or procedure to include all services furnished on the day of surgery and paid separately for visits and services furnished after the day of the procedure.  Subsequently, however, Congress enacted Section 523 of the Medicare Access and CHIP Reauthorization Act of 2015 which prohibited CMS from implementing this policy and required that the agency gather data on visits in the post-surgical period that could be used to accurately value these services.

In the 2017 Physician Fee Schedule Proposed Rule, CMS proposed a three-part data collection strategy, which included:

• Comprehensive claims-based reporting about the number and level of pre- and post-operative visits furnished for 10- and 90-day global services;
• A survey of a representative sample of practitioners about the activities involved in and the resources used in providing a number of pre- and postoperative visits during a specified, recent period of time, such as two weeks; and
• A more in-depth study, including direct observation of the pre- and postoperative care delivered in a small number of sites, including some Accountable Care Organizations (ACOs).

Pursuant to the first prong of CMS’s proposal, all practitioners would be required to submit claims with new G codes for each visit provided during the pre- and post-operative period of a global code, even though they are not paid separately for those services.  The new G codes would indicate the setting of the visit, whether it was furnished by a practitioner or clinical staff, whether it was typical or complex, and the visit’s length of time in 10-minute increments.  

On August 26, 2016, the Medicare Payment Advisory Commission (MedPAC) issued comments on CMS’s proposal, calling CMS’s proposal “too burdensome and costly for providers and CMS.”  Rather, MedPAC urged CMS to adopt a single-pronged approach of only collecting data on pre-and post-operative services from a sample of efficient providers who furnish global codes, with mandatory participation by the sampled providers.

Led by Reps. Larry Bucshon, M.D. (R-Ind.) and Ami Bera, M.D. (D-Calif.), approximately 112 congressional representatives also spoke out against CMS’s data collection proposal in a September 16, 2016 letter.  The lawmakers indicated that CMS’s proposal “disregards congressional mandate” and “will impose an undue administrative burden on the surgical community, disproportionately directing provider resources toward compliance and away from patient care.”

The congressional letter is available here.