California physicians are overwhelmed with unnecessary, burdensome regulations that take time and resources away from providing quality patient care. These regulations are a major contributing factor to the disturbing trend in physician burnout. The California Medical Association (CMA) submitted comprehensive comments urging the Centers for Medicare and Medicaid Services (CMS) to reduce the regulatory burdens under the Medicare and Medicaid programs.

As part of the comment period for the proposed Medicare physician payment rule for 2018, CMS is soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles. CMA submitted its top 10 priorities for regulatory relief, which were developed by the CMA Health Care Reform and MACRA Technical Advisory Committees. The recommendations submitted by CMA would simplify the Medicare/Medicaid programs, reduce costs, improve quality, increase access to physicians and allow physicians to spend more time with their patients. CMA’s top 10 priorities for regulatory relief are:

1. Reduce the quality and electronic health record (EHR) reporting burdens of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).


2. Enforce EHR vendor compliance and interoperability, and limit additional physician fees.


3. Reform the Medicare Recovery Audit Contractor program, and pre- and post-payment review audits.


4. Require Medicaid programs and Medicaid managed care plans to arrange and pay for interpreter services.


5. Reduce health plan data requests of physicians related to Medicare advantage risk adjustment scores.


6. Further delay and simplify the new imaging appropriate use criteria program.


7. Remove lab certification requirements for physicians who use waived tests or physician performed microscopy.


8. Rescind the Two-Midnight/Observation Care rule.


9. Exempt physician in-office drug compounding from the new FDA rule.


10. Change the Stark anti-kickback restrictions to allow more coordinated care alternative payment models.

CMA also submitted comments on the proposed 2018 Medicare Physician Fee Schedule. CMA is pleased to note that there are a number of positive proposed changes that would help physicians improve patient care, including reduced penalties under the flawed Value Modifier program, additional coverage for telehealth services, expansion of the Medicare Diabetes Prevention Program, delay in the implementation of the Imaging Appropriate Use Criteria Program, and reduced documentation requirements for the Medicare Shared Savings ACO Program.

This year also marks the second year of the CMA-sponsored California Geographic Practice Cost Index (GPCI) fix. The GPCI fix updated California’s Medicare physician payment regions in 2017 and will transition payment levels upwards for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts.

However, CMA objected to the proposal to report 2016 Physician Quality Reporting System (PQRS) quality data on the public Physician Compare Website because the inaccuracy of the data could mislead patients. Finally, CMA urged CMS to focus fee schedule revisions on the evaluation and management (E/M) guidelines, not the E/M codes, and to remove the new requirement for physician-office labs to report private payor payment data on tests performed for patients.

For more details on CMA’s priorities for regulatory relief, and CMA’s comments on the proposed fee schedule, click here.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmadocs.org.