Most Physicians Avoid Major Payment Cuts in Medicare Proposal


July 13, 2021 12:28 pm

Most physicians, surgeons, and specialists would see only minor increases or reductions in their Medicare payment rates next year under a proposal released Tuesday by the Biden administration.

The rate reductions outlined in the proposed 2022 Medicare physician fee schedule are due to budget neutrality provisions in the Medicare Act that require program payment hikes be offset by equal reductions elsewhere.

In 2021, the Consolidated Appropriations Act provided a “one-time, one-year increase in the Medicare physician fee schedule of 3.75%” to “provide relief during the COVID-19 public health emergency.” The legislation effectively averted a 3.75% cut in 2021 for providers, who were struggling to recoup revenue they had lost during the pandemic.

Congress isn’t likely to do the same in 2022, now that the Covid-19 vaccines have caused infections and deaths to plummet. But a host of medical organizations are seeking congressional action to head off the proposed cut and others that could be coming later.

David B. Hoyt, executive director of the American College of Surgeons, was still going over the 1,700-plus page rule Tuesday evening, but expressed concerns about the pay cuts.

“It appears that while CMS is taking notable strides to improve health equity and access to care, the rule maintains the cuts to surgical care that Congress stopped last year,” Hoyt said in a statement on behalf on the Surgical Care Coalition. “These cuts harm the care patients need and deserve, which is the opposite of what CMS is trying to achieve. Without congressional action, surgical care faces a significant payment cut and threatens patient access to critical treatments and procedures.”

One-Time Increase Eliminated

Under the new proposed rule from the Centers for Medicare & Medicaid Services, the multiplier—or “conversion factor” used to determine reimbursement for services and procedures in traditional Medicare—would drop slightly to $33.58 in 2022 from $34.89 in 2021. That would erase the one-time 3.75% increase awarded for 2021.

In a statement, Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association, said his organization “is concerned about the potential impact of the proposed 3.75% reduction to the conversion factor due to budget neutrality requirements and will seek congressional intervention to avert the cut.”

In the new proposal, audiologists, cardiac surgeons, pathologists and infectious disease specialists would see a 1% reduction in payments. Cardiologists, allergy/immunologists, and those practicing nuclear medicine and hematology/oncology would see a 2% reduction.

Interventional radiologists, however, would see cuts of 9%, and vascular surgeons face an 8% reduction, while radiation oncologists and radiation therapy centers would see a 5% Medicare pay cut.

Payment rates wouldn’t change for clinical psychologists and social workers, colon and rectal surgeons, critical care providers, general surgeons, or nephrologists under the proposal. Anesthesiologists, neurologists, nurse practitioners, obstetrician/gynecologists, and those practicing internal medicine would see a 1% bump in payments.

Lobbying Congress

The Surgical Care Coalition is lobbying Congress to act before the end of the year to head off roughly 9% in potential Medicare payment cuts in 2022.

The possible cuts next year include the loss of this year’s 3.75% pay hike, the coalition said. In addition, the moratorium on the 2% Medicare sequestration pay cuts also expires at the end of the year, unless Congress takes action to extend it.

And additional Medicare payment cuts of up to 4% are also possible in 2022 after the massive American Rescue Plan increased the federal budget, which triggered mandatory cuts under the Pay-As-You-Go Act of 2010, the coalition said. Congressional action would be needed to waive the PAYGO cuts.

The proposed rule also would allow patients in any geographic location, including their homes, access to telehealth services for diagnosis, evaluation, and treatment of mental health disorders. The proposal would also Medicare to pay for mental health visits provided by rural health clinics and federally qualified health centers.

“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” said a statement from CMS Administrator Chiquita Brooks-LaSure. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”