One of the leading legislative and regulatory priorities for ACEP at the moment is preventing the cuts included in the proposed Medicare physician fee schedule (PFS) for 2021, which are set to take place on January 1. This regulation from the Centers for Medicare & Medicaid Services (CMS) proposes Medicare payment rates for the coming calendar year (CY), and often serves as the basis for which many private payors set their reimbursement rates.
ACEP is working closely with legislators and other physician and non-physician groups affected by the rule to push for, at the very least, a solution that holds physicians harmless from such drastic cuts–especially when many emergency physicians still face unprecedented financial hardships and instability due to the COVID-19 pandemic.
- Less than 20 hours after CMS released the proposed rule, ACEP sent a letter to Congress requesting that it waive the budget neutrality requirement, since it is the only entity with authority to do so. ACEP’s letter to key congressional committees expresses our strong concerns on this proposed cut and notes the unprecedented strain emergency physician practices already are facing due to the ongoing COVID-19 pandemic.
- ACEP responded to CMS’ proposed rule impacting Medicare physician payments for 2021. (For a summary of ACEP’s comments, please click here, and for ACEP’s full comment letter, please click here.) In our comments, we lay out the specific impact that a -6 percent reduction would have on patients’ access to emergency care, highlighting how COVID-19 public health emergency (PHE) will exacerbate the effects of such a reduction. We also make the following three policy recommendations:
- To account for the additional expenses that hospital-based clinicians must absorb when treating patients during the COVID-19 PHE, ACEP strongly urges CMS to implement a 20 percent COVID-19 professional services claims-based payment adjustment.
- ACEP urges CMS to delay the implementation of the add-on code for complexity (GPC1X) to CY 2022 or later or to possibly consider eliminating the code altogether.
- ACEP recommends that CMS and the Department of Health and Human Services (HHS) utilize its 1135 waiver authority under the COVID-19 PHE to waive the budget neutrality requirement for all of CY 2021.
- ACEP is encouraging all our members to reach out to their legislators and urge Congress to hold emergency physicians harmless from these potentially devastating cuts.
Current Legislative and Regulatory Activity
- Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced their own bipartisan bill on October 30, the “Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020,” which would maintain physicians’ reimbursement at 2020 levels – if they were otherwise scheduled to receive a payment cut. The temporary, additional payment would be for two years (2021 and 2022). ACEP, along with a coalition of organizations representing physicians and allied health professionals including the AMA, sent a letter to congressional leaders in support of this legislation.
- Introduction of the bill follows a letter spearheaded by Reps. Bera and. Buchson and signed by a bipartisan coalition of 229 House members to Speaker Nancy Pelosi (D-CA) and Minority Leader Kevin McCarthy (R-CA) urging them to blunt Medicare pay cuts scheduled to begin on Jan. With more than half of the House of Representatives signing the letter, this represents a strong showing highlighting the outreach efforts of emergency physicians and other health care professionals.
- On October 2nd, Representatives Michael Burgess, MD (R-TX) and Bobby Rush (D-IL) introduced bipartisan legislation, R. 8505, to prevent pending Medicare payment cuts by waiving budget neutrality requirements.
- On the Senate side, Sen. Steve Daines (R-MT) sent a letter to Majority Leader Mitch McConnell (R-KY) and Minority Leader Chuck Schumer (D-NY) on Oct. 26 urging them to prevent the Medicare payment cuts as well. He stated his concerns about these cuts placing a further strain on Montana’s health care system and practitioners who are already stressed by COVID.
When CMS announced last year that it was seeking to revalue the office and outpatient evaluation and management (E/M) codes for CY 2021, ACEP advocated strongly for corresponding increases for the ED E/M codes—the most commonly billed codes for emergency medicine. These efforts built on our advocacy to the American Medical Association’s RVS Update Committee (RUC). ACEP also provided data and a solid policy argument to directly to CMS and the White House to strengthen our case. That advocacy paid off, and CMS is now proposing to adopt our specific code values for the ED E/M codes, which increases emergency medicine reimbursement by approximately 3 percent for CY 2021.
Unfortunately, a large increase to primary care E/M codes that CMS finalized last year also takes effect in 2021. Because of the existing budget neutrality requirement under the Medicare PFS, any increases in the value of one code means a corresponding decrease in the value of all other codes (causing the PFS conversion factor, which changes code values into a dollar amount, to decrease by nearly 11 percent in CY 2021, one of the largest cuts in 25 years). Essentially every specialty got a “haircut,” reducing some codes’ increases and exacerbating other’s decreases.
ACEP’s prior advocacy for the increase for the ED E/M codes staved off a bigger reduction in value. Basically, ACEP got you a raise, but CMS budget neutrality rules cancelled it out. CMS even says as such in the rule, "For emergency medicine practitioners, estimated impacts of -6 percent reflect a 3 percent gain as a result of proposed increased valuations to emergency department visits using specialty society [that’s ACEP!] recommendations to maintain relativity with office/outpatient E/M visits. However, the magnitude of the office/outpatient E/M visit valuations are dampening the effect of increased valuations for the emergency department visits."