On July 7, the Centers for Medicare and Medicaid Services (CMS) proposed its 2023 updates to the Medicare Physician Fee Schedule. This annual rule revises payment policies under the Medicare physician fee schedule and makes other policy changes to payments under Medicare Part B. The rule also proposes updates to the Quality Payment Program in an effort to increase clinician participation through the Merit-based Incentive Payment System Value Pathways (MVPs) and encourage participation in Advanced Alternative Payment Models, among others.
In the rule, CMS is requesting public feedback on whether to allow continual medical education organizations (CMS definition) to directly submit improvement activities for MVPs, which would, subsequently, require creating a new type of third-party intermediary. In addition, this RFI seeks feedback on the value of the implementation of policies to approve CME Organizations or accreditation entities as third-party intermediaries.
Comments are due September 6, 2022.
More from Proposed Rule
In the rule, CMS describes its interest in the issue:
“We have signaled an interest in aligning MIPS with efforts clinicians undertake to
maintain their state licensure and, as appropriate, board certification status, which often requires completion of Continuing Medical Education (CME) requirements and/or Maintenance of Certification (MOC) requirements. We are considering whether national continuing medical education (CME) accreditation organizations that provide certification of CME could serve as a new type of third party intermediary to submit data for clinicians seeking improvement activities performance category credit for IA_PSPA_28, “Completion of an Accredited Safety or Quality Improvement Program,” and IA_PSPA_2, “Participation in MOC Part IV,” which are both medium-weighted improvement activities, so that clinicians would not need to attest to completion of the improvement activities through the QPP web portal. We are considering how to include information from national CME accreditation organizations in MIPS.”
Currently, only third party intermediaries, such as QCDRs, qualified registries, health IT vendors, and CMS-approved survey vendors are the only entities that are permitted to submit attestations on behalf of clinicians. CMS proposes an approach to include CME accreditation organizations as the third party intermediary. However, current policies do not allow third party intermediaries to submit data solely for the improvement activities performance category.
CMS wants to establish a different type of third party intermediary that will allow national CME accreditation organizations to submit improvement activities based on completion of CME or MOC for the improvement activities performance category. The agency is seeking comment on whether a new type of third party intermediary would be “valuable to clinicians.” CMS believes if it adds this new intermediary, that it should “consider only national CME accreditation organizations” in an effort to “reduce potential clinician confusion and program complexity.”
CMS says it is interested in the value to clinicians, including burden reduction, to allow CME accreditation organizations to submit one or two improvement activities. The agency explains it is further interested in numerous things, such as the types of organizations that should be considered if it establishes a different type of third party intermediary, and what benefits and barriers to the CME accreditation organizations may exist.
CMS continues, stating that it is “requesting feedback on the value to clinicians of the program including CME accreditation organizations as a new type of third party intermediary that submits data on improvement activities that align with efforts clinicians undertake to complete CME, rather than attest to completing the activity at the time of submission.” The agency issues a number of questions in the format of 12 bullet points asking for feedback from the CME industry and other interested parties. Questions include:
“What is the value to clinicians for adding a new third party intermediary as an
alternative method of data submission for the two improvement activities noted above, rather than attesting to completion of the improvement activities?”
“If a new type of third party intermediary was created for reporting only the improvement activities performance category, are CME accreditation organizations interested in developing capacity over time to submit additional improvement activities in the Improvement Activities Inventory, especially activities that address CMS priority issues, such as closing the health equity gap, inclusion of the patient voice in quality improvement, shared decision-making, and care coordination?”
“As the program transitions to MVPs, we are interested in reducing complexity and burden for clinicians. Would CME accreditation organizations need to be able to support MVPs (submission of measures and activities for quality, Promoting Interoperability and improvement activities performance categories) to reduce burden?”
ACCME Response
“The Accreditation Council for Continuing Medical Education (ACCME) commends the Centers for Medicare and Medicaid Services (CMS) for the proposed rule. We stand ready to report physician learner data documenting completion of accredited CME activities that address performance improvement and quality improvement. This is one of the many benefits of our ongoing effort to digitize accredited CME data to reduce reporting burdens on physicians. Engaging clinicians in activities that help them reflect on their own practice and patients not only creates useful and actionable feedback to those healthcare providers, but also helps their patients attain optimal outcomes from that care. We urge accredited CME providers and physicians to express their support for the proposed rule.”
Graham McMahon, MD, MMSc, ACCME President and CEO
Analysis
This represents a huge opportunity for CME/CE providers to serve their learners. The proposed rule ensures that CME/CE providers are in the perfect position to help clinicians who participate in CME/CE and MOC activities meet their payment goals.
The CME Coalition, ACEHP and similar organizations will be providing more information to their members in the coming days.