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Washington Update: SVS Submits Comments on Proposed Rules

The SVS submitted comments to the Centers for Medicare and Medicaid Services in September on two important Proposed Rules affecting vascular surgeons: the 2018 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS).

Final Rules were expected to be issued in early November. The comments are at

The SVS requested regulatory relief, including minimizing 2018 penalties, from the Value-based Payment Modifier (VPM), Meaningful Use of EHRs and the Physician Quality Reporting System (PQRS). Specifically, the SVS requested that CMS establish a modifier adjustment of zero percent for 2018. Authorized by the Affordable Care Act (ACA), the VPM is to provide payment adjustments "based upon the quality of care furnished compared to cost."

Because the VPM was enacted as part of the ACA, the program is subject to President Trump’s first Executive Order. This directs the secretary of Health and Human Services to "exercise all authority and discretion" available to it to "waive, defer, grant exemptions from, or delay the implementation of any provision of the ACA that imposes a penalty or regulatory burden on healthcare providers." The 2018 VPM imposes a significant regulatory burden on physicians and the VPM adjustment of up to 4 percent constitutes a sizeable penalty, the SVS said.

Establishing a zero percent modifier is not only consistent with the governing statute and this Executive Order, it is consistent with sound public policy, SVS asserted.

The SVS also recommended that CMS adopt broader hardship exemptions for the Meaningful Use of EHR and make PQRS more rational and fair by making reporting less onerous. One method would be to reduce the number of quality measures required to be reported, minimizing the number of physicians subject to PQRS penalties.

For the HOPPS Proposed Rule, the SVS opposed changes to the "imaging without contrast" Ambulatory Payment Classification (APC) that would add complete vascular ultrasound services to the same classification as limited vascular ultrasound services. This would result in an estimated $70 million reduction to this subset of vascular ultrasound procedures, which seriously threatens hospitals’ capacity to provide these services, SVS said.

In addition, the Deficit Reduction Act of 2006 is still in effect, with HOPPS payments being used to replace the fee schedule payments for technical components of imaging services. This is causing grave consequences for vascular surgeons performing these services in the non-facility setting. SVS recommended that CMS establish a "non-invasive studies" classification consisting of two payment levels.

At least 35 SVS members also submitted comments, describing the impact this proposed APC would have on them. With the recent resignation of HHS Secretary Dr. Tom Price, it is difficult to determine how CMS will respond to SVS’ comments on these issues.