Friday, November 19, 2021

Rarity: Federal Register Mishandles CMS Physician Fee Schedule Final Rule

Here's extreme Medicare nerdism, but it's one I've never seen before.  

CMS released a "typescript" or "inspection copy" of the Physician Fee Schedule annual rule on November 2, and the fully printed and typeset version appeared today November 19 in the Federal Register.

They've badly mispaginated it, which I assume they'll eventually correct.

If you go to the home page for this publication, the PFS rule, today, it's here:

And it gives a link to the PDF rule, and lists the pagination as 508 pages from page 65524-66031.

This pagination, and the document offered for download, are incorrect.  They have posted a document that starts in the middle of the CY2022 PFS rule.

I tracked back and downloaded the entire Federal Register issue.   The correct pagination is not 65524-66031, but 64996-66091 (about 1095 pages).   Another observation is that, at 1095 pages, the PFS rule is almost the entire Federal Register for today (the whole issue is 1364 pages).  The PFS weighs in at 165MB of a total of 174 MB.


See a discussion of the PFS rule CY2022 by Suzanne Michelle Joy at Holland & Knight, here.


400 Pages of Quality Measure Appendix

Up to Secretary Becerra's signature, on page 65686, it's 691 pages.  After that, 400 pages of Appendix regarding quality measure rulemaking.

Anti-Racism Plan For Quality Measure Activities

On Page 65384, discussion of a quality measure anti-racism plan.  The goal is to help "clinicians move beyond analyzing data, to taking real steps to naming and eliminating the causes of the racial disparities identified [65969]."  It includes "an organization's plan to prevent and address racism and/or improve language access and accessibility."


In Appendix 2: Improvement 

Activities of this final rule, we 

discussed an improvement activity 

titled ‘‘create and implement an anti- 

racism plan’’. This improvement 

activity acknowledges it is insufficient 

to gather and analyze data by race, and 

document disparities by different 

population groups. Rather, it 

emphasizes systemic racism is the root 

cause for differences in health outcomes 

between socially defined racial groups. 

Further, we also proposed to modify 

five existing improvement activities to 

address health equity. We note that 

some improvement activities within our 

current Inventory already aim to 

improve equity. We believe further 

modifying them can more explicitly link 

the activity to health equity without 

changing the core activity. In other 

cases, our proposals to modify an 

activity fundamentally shifts the activity 

to focus on health equity specifically.

See tables, page 65969.  A quality measure for anti-racism actions and activities in the healthcare setting implements Executive Order 13985, January 20, 2021.

For a 20p PDF of equity & quality measures discussions, see here.