AHA Comments on CMS Physician Fee Schedule CY 2025 Proposed Rule

September 09, 2024

The Honorable Chiquita Brooks-LaSure
Administrator
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W., Room 445-G
Washington, DC 20201
Submitted Electronically

Download the Letter PDF

RE: CMS–1807–P Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments

Dear Administrator Brooks-LaSure:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations; our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers; and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) physician fee schedule (PFS) proposed rule for calendar year (CY) 2025.

The AHA applauds CMS’ proposals to extend many telehealth regulatory flexibilities through 2025. There are, however, many statutory waivers that are also scheduled to expire at the end of the year. As such, we urge CMS to work with Congress to extend these telehealth provisions. Their expiration would result in a telehealth “cliff,” risking reducing access to care for the millions of Americans who rely on virtual modalities to receive necessary services. As we have previously advocated, we cannot emphasize enough how essential waivers like removing geographic and originating site restrictions are to the provision of care and continued access to services.¹

We are also pleased that the agency proposes to exclude significant, anomalous and highly suspect (SAHS) from Medicare Shared Savings Program (MSSP) financial calculations. As we have previously commented, the inclusion of SAHS billing can have a significant impact on these calculations, in many cases resulting in a loss of shared savings.² We applaud the agency for taking quick action to develop proposals to address concerns raised by stakeholders.

However, we are deeply concerned with the proposed payment update, which would reduce payments by approximately 2.8% from their CY 2024 levels. This negative update comes after over two decades of conversion factor decrements and in the face of significant staffing shortages, rising inflation and unrelenting financial pressures. We are concerned that such a reduction in payment would pose significant risks to patients’ access to care. Indeed, a recent Medicare Trustees report highlights the potential impact of continued payment decrements on disparities in care. We urge CMS to work with Congress to provide a payment increase for 2025 and to develop a long-term plan for sustainable physician payment.

Finally, we have concerns regarding CMS’ proposed updates to Medicare Parts A and B overpayment policies. As we have previously commented, we continue to assert that CMS’ reliance on UnitedHealthcare Insurance Co. v. Azar to remove “reasonable diligence” standards does not, in our view, hold what CMS understands it to hold.³ Additionally, while we appreciate that CMS acknowledges that additional time beyond 60 days is needed to complete investigations of overpayments, the proposed 180-day window to suspend reporting and repayment is insufficient. We urge CMS to provide sufficient exceptions when complex, multi-year or multi-site investigations necessitate additional time beyond 180 days.

We appreciate your consideration of these issues. Our detailed comments are attached. Please contact me if you have questions or feel free to have a member of your team contact Jennifer Holloman, AHA’s senior associate director of policy at jholloman@aha.org.

Sincerely,

/s/

Ashley B. Thompson
Senior Vice President
Public Policy Analysis and Development

Enclosure