Lawmakers Seek Bipartisan Solution for Physician Fee Schedule Cuts

Over 200 Representatives are calling on Congress to examine possible bipartisan solutions to address proposed Medicare Physician Schedule cuts for certain specialties, including surgical care.

In a proposed rule from August 2020, CMS stated it plans to reduce Physician Fee Schedule rates for certain services in order to increase rates for more evaluation and management services, including office visits for primary care and chronic disease management.

Physician reimbursement under the proposed rule could decline by as much as 11 percent for some specialties, the American Medical Association (AMA) reported. Those specialties include anesthesiology, critical care and emergency medicine, respiratory specialists, radiology, and lab pathology, all of which have been on the frontlines of the COVID-19 pandemic.

Surgical care could also take up to a 9 percent cut depending on specialty, the Surgical Care Coalition added.

“Payment cuts of this magnitude will surely strain a health care system that is already stressed by the COVID-19 pandemic and could jeopardize patient access to medically necessary services,” wrote the coalition of 229 Representatives led by Ami Bera, MD (CA-7) and Larry Bucshon, MD, FACS (IN-8). “In order to safeguard beneficiaries' access to care during this pandemic, we as Congress should examine possible bipartisan solutions to address excessively steep cuts.”

The coalition sent the letter to Speaker of the House Nancy Pelosi and House Minority Leader Kevin McCarthy.

The fee schedule cuts are the result of budget neutrality requirements. CMS must ensure that the Medicare Physician Fee Schedule is budget neutral, meaning rate increases must be offset by cuts to other areas of the fee schedule.

While supportive of increasing rates for primary care and other office-based services, the budget neutrality requirements will leave many specialists facing substantial rate cuts beginning January 1, 2021, if Congress does not act before the end of the year, the coalition explained.

CMS has yet to finalize the rule for the CY 2021 Medicare Physician Fee Schedule because of delays caused by the COVID-19 public health emergency.

Specialists, however, are supporting efforts to stop the rate cuts that would disproportionately impact some specialties more than others.

“As physicians themselves, Reps. Bera and Bucshon understand the challenges the healthcare system is facing as a result of this pandemic, and that now is not the time to create further obstacles to patients’ access to surgical care by cutting Medicare payments to physicians,” said David Glasser, MD, American Academy of Ophthalmology Academy Secretary for Federal Affairs. “We thank Representatives Bera and Bucshon for their leadership and support on this issue to ensure older Americans do not see their care jeopardized as a result of these cuts.”

The Surgical Care Coalition, which represents more than 150,000 surgeons, has also urged Congress to stop the rate reductions if they are finalized. A survey conducted earlier this year by founding member American College of Surgeons found that almost one-third of the 1,000 surgeons surveyed said they will have to reduce their Medicare patient intake because of the rate cuts.

Additionally, one in five surgeons said they may need to stop performing certain procedures to decrease costs as a result of the cuts.

“These CMS cuts will be devastating to patients across the country, and this survey illustrates the tough choices that all surgeons will be forced to make,” said Valerie Rusch, MD, FACS, president of the American College of Surgeons. “In order to ensure Medicare patients continue to have the best access to the best care – when they need it and where they need it – Congress needs to stop these cuts from taking effect.”

Surgeons and other specialties targeted by proposed rate cuts have been particularly affected by the COVID-19 public health emergency. Many of the specialists faced significant volume declines when the government shut down elective, non-emergent procedures at the height of the pandemic. The specialists are only just rebounding from the declines.

The rate cuts stemming from the budget neutrality requirements have also been criticized by leading industry groups, including the American Hospital Association and the American Medical Association.