Providers, Lawmakers Say #StopTheCuts to Physician Fee Schedule

With payment reductions looming for many providers paid under the Medicare Physician Fee Schedule, hundreds of medical organizations and lawmakers are pushing Congress to stop rate cuts finalized in rule from CMS.

The rule released earlier this month finalized a $3.68 decrease in overall Fee Schedule payments to physicians starting January 1, 2021. But the rule also increased the rates for many primary care and chronic disease management services in an effort by CMS to incent “interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses.”

However, a budget neutrality requirement that mandates any change in expenditures over $20 million be offset by rate changes elsewhere in the Fee Schedule resulted in significant rate cuts for other physician services payable under the Fee Schedule.

As a result, more than 1 million healthcare providers are slated to face payment cuts as high as 10 percent due to the budget neutrality requirement, according to the group of nearly 400 national, regional, state, and local medical organizations and 329 members of Congress.

Many of the providers affected by the cuts are also working on the frontlines of the COVID-19 pandemic and include anesthesiologists, critical care and emergency medicine providers, respiratory specialists, radiologists, and lab pathologists, provider groups have said.

Now, many of those organizations are telling Congress to #StopTheCuts as part of any year-end legislative package to support healthcare providers during the ongoing pandemic.

“While the COVID-19 pandemic rages and wreaks havoc on the health care system, providers continue to contend with overflowing hospitals and the financial impact of the spring-summer government-recommended shutdown of most non-urgent medical care. Against this backdrop, double-digit Medicare cuts will be devastating for patients, communities and providers,” the American College of Radiology (ACR), one of the supporting organizations, said in a statement.

Other medical organizations supporting the campaign include the American Medical Association (AMA), Association of American Medical Colleges (AAMC), AMGA, and hundreds of associations representing specialists.

The organizations and lawmakers are advocating legislation, which includes a House bill introduced by Representative Ami Bera (D-CA) in October and, more recently, a Senate bill introduced by John Boozman (R-AR).

Both pieces of legislation aim to prevent the rate cuts from happening on January 1.

So far, 278 House members have cosponsored legislation and/or signed letters urging leadership to act before the end of the year. Similarly, 51 senators have signaled support for addressing the rate cuts in a year-end legislative package.

“Health care professionals across the spectrum are reeling from the effects of the COVID-19 emergency as they continue to serve patients during this global pandemic,” Senators John Boozman (R-AR), Bob Menendez (D-NJ), Steve Daines (R-MR) and Debbie Stabenow (D-MI) and 46 other Senators recently wrote to Senate leaders. “The payment cuts finalized by CMS would pose a threat to providers and their patients under any circumstances, but during a pandemic the impact is even more profound.” 

Medical organizations have expressed concerns about the rate cuts if Congress fails to resolve the issue before the new year. Many fear that they could lead to more practices and institution-based providers furlough or cutting staff, or worse, closing their doors for good.

This could further reduce access to needed healthcare for seniors, especially those in rural and underserved areas, ACR stated.

Other provider groups are also criticizing the finalized rate cuts for certain specialists, including The Alliance for Physical Therapy Quality and Innovation (APTQI), which commended the bipartisan group of Senators for calling for a stop to the cuts.

“The financial impact of the COVID-19 public health emergency – in conjunction with steep Medicare payment cuts – would deal an irrevocable blow to America’s healthcare infrastructure. With the clock ticking, it’s critical for lawmakers to move quickly to get this legislation through Congress and onto the president’s desk for signature before the cuts take effect January 1,” said Nikesh Patel, PT, executive director of APTQI.