Pallone Wants Bipartisan Effort To Avert Doctor Pay Cuts — But Not Now

Inside Health Policy

September 20, 2021 2:38 pm

House Energy & Commerce Chair Frank Pallone recently pledged to work with lawmakers from both parties moving forward to avert physician pay cuts, but the New Jersey Democrat said now’s not the time to act given CMS just received comments on its proposed 2022 fee schedule. Lawmakers from both parties want to eventually stop the cuts, but E&C Democrats rejected a GOP bid this week to add a pay fix to the emerging budget reconciliation bill.

Meanwhile, physicians and lawmakers are also pressing CMS to back away from the cuts on its own.

The American Medical Association has estimated that certain providers could be looking at an almost 10% cut, unless lawmakers step in.

Some providers could see pay cuts in 2022 due to a variety of policies, from the end of the sequester moratorium to a phase-in of certain cuts tied to changes to evaluation and management pay under the physician fee schedule and changes to clinical labor policies under the proposed 2022 physician fee schedule, among others.

Rep. Larry Bucshon (R-IN) said Wednesday (Sept. 15) during the Energy & Commerce reconciliation markup that Democrats’ bill essentially ignores that some physicians could see a substantial cut in 2022. He called for an amendment to extend for a year the 3.75% payment adjustment that Congress put in place last year in order to ease cuts tied to changes to evaluation and management pay policies under the physician fee schedule.

“This idea isn’t partisan,” he reminded lawmakers, pointing to efforts with Rep. Ami Bera (D-CA) to head off physician cuts. “As we consider a bill that comes with a high price tag of a trillion dollars, why not set aside a very small fraction of that to say thank you to our health care heroes by providing them with the certainty and support they so admirably deserve.”

Bucshon’s comments came just days after Rep. Brad Wenstrup (R-OH) raised concerns at a House Ways & Means markup about adding more providers to a Medicare pay system that is already unstable, and he also pointed to the looming physician pay cuts.

Rep. Kurt Schrader (D-OR), who voted against adding hearing, vision and dental benefits to Medicare during the House Energy & Commerce markup, said dentists might not want to be part of a program that has had unstable pay rates, pointing to the historical Sustainable Growth Rate payment formula and fixes lawmakers routinely put in place to avoid cuts to doctors.

House Ways & Means Chair Richard Neal (D-MA) said he would work with Wenstrup on the physician pay issue, and, while Bucshon’s amendment was defeated, Pallone said he hopes to find a bipartisan solution in the future.

“I do not think this is the right time or place to address these issues,” Pallone said, noting stakeholders’ myriad concerns. “The comment period on the physician fee schedule only recently closed and the final rule is under development. I do think ensuring robust physician payment is an important issue…I look forward to working with stakeholders and members on these issues as we go forward.”

The American Medical Association late last month raised alarm about the upcoming Medicare cuts and asked that the reconciliation package be used to instruct lawmakers to draft and mark up legislation to prevent a so-called pay cliff for physicians come January 2022.

A draft letter to congressional leadership spearheaded by Bera and Bucshon said a short-term fix is needed to deal with payment instability while a longer-term solution for the Medicare pay system for providers is found.

“We believe broad systemic reforms to the payment system are critical to speed the transition to value-based care. However, as Congress begins the complex process of identifying and considering potential long-term reforms, we must also create stability by addressing the immediate payment cuts facing health care professionals. These cuts will strain our health care system and jeopardize patient access to medically necessary services,” a draft of the letter says (emphasis theirs).

Reps. Bobby Rush (D-IL) and Gus Bilirakis (R-FL), meanwhile, spearheaded a letter signed by more than 70 lawmakers sent directly to CMS urging the agency not to move forward with their proposed changes to the clinical labor policy in the proposed 2022 physician fee schedule, as the changes could lead to up to 20% cuts for certain provider types. The lawmakers raised concerns in particular with the budget-neutral nature of CMS’ proposed changes — though the agency can’t change the budget-neutral aspect of the rule.

“Considering that the second-order negative effects of PFS ‘budget neutrality’ strongly outweigh incorporating new clinical labor data, we strongly recommend CMS not finalize the clinical labor policy at this time in the 2022 PFS Final Rule,” the lawmakers said.

They also urged CMS to work with them to avoid the 3.75% cut that would come from phasing in the reductions tied to changes to evaluation and management pay changes.

“Moreover, considering PFS ‘budget neutrality’ effects from the 2021 PFS Final Rule E/M policy are still causing negative impacts in the form of a scheduled 3.75 percent cut to the conversion factor in 2022, we urge you to work with Congress on fundamental reform to the PFS in order that we may better address the upcoming 3.75 percent cut in legislation later this year.” — Michelle M. Stein (