House Dems Look to Prevent Medicare Payment Cuts

UPDATE 12/08/2021: A deal has been reached to avert some of the pending Medicare payment cuts. Congressman Steven Horsford (D-NV) and Congresswoman Kim Schrier (D-WA) introduced the Supporting Health Care Providers During the COVID-19 Pandemic Act, which has bipartisan support from leadership in the House and Senate. More updates to come.

House Democrats are urging President Biden and Congress to prevent looming Medicare payment cuts after lawmakers failed to stop the cuts as part of the continuing resolution last week.

The House and Senate passed H.R. 6119 on Dec. 2, 2021, to extend funding for federal programs through Feb. 18, 2022. The continuing resolution averted a government shutdown. However, healthcare groups were lobbying for the bill to also extend the moratorium on Medicare sequester cuts or at least prevent the statutory “Pay-As-You-Go” sequester, known as PAYGO.

Together, the Medicare and PAYGO sequester cuts would reduce Medicare payments to physicians by about 6 percent. Physicians already face a 3.75 percent reduction in Medicare reimbursement in 2022 after CMS finalized the Medicare Physician Fee Schedule final rule in November.

“Cutting Medicare reimbursement to our health care heroes during a pandemic is simply unacceptable,” the Congress members led by Susan Wild (D-PA) and Cynthia Axne (D-IA) said in the Dec. 6 letter to President Biden and several Congressional leaders.

“We stand ready to work with you to introduce, whip for, and vote to pass legislation to reverse these cuts, as well to work with you to identify ways to pay for reversing these cuts. We are opposed to paying for preventing these cuts with additional provider cuts,” they wrote.

The group, which totaled 18 Congress members, also called on the President and Congress to reverse Medicare payment cuts slated to impact radiation oncologists under the Radiation Oncology Model (RO Model).

As part of Medicare’s Hospital Outpatient Prospective Payment System (OPPS) final rule for 2022, CMS made several changes to the RO Model, an alternative payment model that will test prospective, site-neutral payments for radiotherapy services. The model was previously slated to start on Jan. 1, 2021, but was delayed because of the COVID-19 pandemic. The 2022 OPPS final rule provided a new start date of Jan. 1, 2022, and made several changes to the model, including a 3.5 percent professional discount and a 4.5 percent technical discount.

The American Society of Radiation Oncology (ASTRO) has criticized the final rule, arguing that the new start date and model changes will harm treatment facilities. The organization said that these issues, in conjunction with steep planned Medicare payment cuts, would force many facilities to reduce services or close altogether.

Healthcare providers have already said that reinstating Medicare and PAYGO sequester cuts, along with reductions to Medicare Physician Fee Schedule, would impact operations.

A poll conducted by AMGA (American Medical Group Association) earlier in the fall found that almost half (47 percent) of medical groups and integrated health systems would have to redesign physician compensation arrangements if the cuts are implemented in 2022. Another 43 percent said they would put a freeze on hiring despite widespread staffing shortages.

“During COVID and with everything that we experienced, by that I mean elective surgery stopped much like it did for everybody else, we furloughed half of our 1,000 employees. I don’t want to do that again under Medicare cuts,” Carol Brockmiller, CEO of Quincy Medical Group, an independent, multi-specialty, physician-owned group based in Illinois, said in during an AMGA press call in October.

Scott Hines, MD, chief quality officer of Crystal Run Healthcare and chair of AMGA’s Public Policy Committee, also said during the call that investments in care transformations, such as the move to value-based care, would also need to be reconsidered in light of revenue reductions.

“It costs a lot of money to transform the way that you deliver care to a model that breeds accountability, value, and outcomes, and you need to invest in personnel, technology, and infrastructure. These cuts are going to make that much more difficult and prevent the rapid progression that we would like to achieve,” Hines stated.

The Medicare payment cuts are expected to go into effect on Jan. 1, 2022.