The Centers for Medicare & Medicaid Services (CMS) issued the 2021 Medicare Physician Fee Schedule (PFS) proposed rule on August 3, 2020. The proposed rule contains significant cuts that will, unfortunately, further strain an already stressed health care system. The proposed cuts may threaten physician practices while potentially creating additional risks to patient access to care during this unprecedented Covid-19 pandemic and resulting economic downturn. Without Congressional action, CMS will implement these cuts on January 1, 2021. SCAI is urging Congress to stop these cuts before they go into effect.

The proposed reductions are primarily driven by new Medicare payment policies for office and outpatient visits or evaluation and management (E/M) codes. To make those increases budget neutral, CMS plans to reduce payments for all other procedures. Specifically, SCAI is requesting that Congress waive the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act before the final E/M code proposal is implemented on January 1, 2021.

This critical action by Congress, for inclusion in any forthcoming legislative package, will provide a critical reprieve for a broad scope of health care professionals facing substantial payment reductions in the coming months.

Action Requested

SCAI members are strongly encouraged to ask their Representatives to immediately co-sign and support the bipartisan Burgess-Rush bill (H.R.8505), legislation that would prevent the proposed 10 percent Medicare payment cuts planned by the Centers for Medicare and Medicaid Services (CMS). Please use the link provided here to find your elected officials.

press release from SCAI President Cindy Grines, MD, MSCAI outlines our concerns. A draft letter has been provided here as an example of the appropriate language to include in your communications with your Member of Congress.

For questions, contact Curtis Rooney, Vice President, Government Relations, crooney@scai.org. Tell us what your Congressional office says.

Background

In 2019, CMS finalized broad changes related to E/M services to reduce administrative burden, improve payment rates, and reflect current clinical practice. The health care community-supported restructuring and revaluing the office-based E/M codes, which will increase payments for primary care and other office-based services. Unfortunately, by law, any changes to the PFS cannot increase or decrease total expenditures significantly. As a result, any increases must, therefore, be offset by corresponding decreases.

CMS estimates that the 2021 policies will increase Medicare spending by $10.2 billion and cause a reduction of the Medicare conversion factor from $36.0896 to $32.2605 (i.e., a 10.6 percent decrease). SCAI maintains that the cuts to Medicare will harm physicians, their practices, and most importantly, their patients. Compounding the problem is the fact that Medicare payments have failed to keep up with inflation since the inception of the PFS in 1992. This decrease in the 2021 conversion factor will be below the 1994 conversion factor of $32.9050 — which is worth approximately $58.02 today!