Across the board, providers are unhappy and vocal about the calendar year 2021 pay rule released by the Centers for Medicare and Medicaid Services (CMS) last week. Due to strict budget neutrality, the agency offset a pay increase for primary care providers by cutting payment to specialists by up to 10%.
Primary care doctors and nurses are set to receive a pay boost of 7% this year from CMS, but reductions in other areas like neurosurgery, long-term care, emergency physicians, physical therapists, radiologists, as well as portable X-rays and other Medicare Part B services are raising alarms. Additionally, private insurers often set their own rates by Medicare reimbursement standards, which drives reimbursement for much of the overall market.
The Society of NeuroInterventional Surgery, an association representing neuroendovascular care professionals joined a coalition of professional groups urging Congress towards a legislative solution, according to Healthcare Finance. Cuts to neurointerventional procedures will land in the range of 10%.
McKnight’s reports that physical and occupational therapists for nursing home patients are facing a cut of 9%, compounding the 8% cut they took last year. ADMA – The Society for Post-Acute and Long-Term Care Medicine and the National Association of Support for Long Term Care swiftly released statements condemning the cuts, specifically in the midst of a pandemic.
From AMDA executive director Christopher E. Laxton, CAE:
It is inexplicable, in light of the surging COVID-19 crisis, that CMS has chosen to impose this drastic cut on the very clinicians who, at great risk to themselves and their families, have been battling this deadly virus at ground zero for the past nine months.
From Cynthia Morton, executive vice president of the National Association of Support for Long Term Care:
The action that CMS took to finalize these policies that impact nursing facility patients is shocking in that CMS is significantly cutting services that help out patients recover from COVID or keep themselves healthy and hopefully not succumb to COVID-19
Emergency physicians will receive a 6% pay cut, according to Healio News. The American College of Emergency Physicians (ACEP) also announced its dismay at these cuts. ACEP supports the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020,” introduced in late October to the House by Representative Ami Bera (D-CA) in October. The bill has not yet advanced. From Mark Rosenberg, DO, MBA, FACEP and president of ACEP:
Emergency physicians and other health care providers battling on the frontlines of the ongoing pandemic are already under unprecedented financial strain as they continue to bear the brunt of COVID-19. These cuts would have a devastating impact for the future of emergency medicine and could seriously impede patients’ access to emergency care when they need it most.
Over 60 provider organizations signed a statement addressed to Congress, voicing their objection to the cuts and support the for the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020. In the statement, they directly appealed to Congress to take action, following appeals to CMS that they felt went completely unheard.
Due to CMS’ unresponsiveness to address these concerns, organizations representing more than 1 million physicians and nonphysician health care providers across the United States urge Congress to include legislation in any year-end package to prevent these arbitrary Medicare cuts in order to protect patient access to medically necessary services.
The National Association of ACOs (NACCOS) also released a statement, as the rule provides broad changes to quality assessments in the Medicare Shared Savings Program (MSSP) as well. NAACOS says that this sudden change does not allow ACOs time enough to prepare for changes before the rule goes into effect on January 1.
NAACOS urges CMS and the incoming administration to reconsider many of the ACO quality changes finalized in the 2021 Medicare Physician Fee Schedule (MPFS) rule and to work more closely with stakeholders to find appropriate solutions for streamlining ACO quality while maintaining quality as a core focus of the ACO program.
Also, the American Telemedicine Association requested support from CMS in the pay rule in order to expand access to telehealth services and include more providers. Even though telehealth was expanded in the final rule, CMS Administrator Seema Verma alluded to telehealth returning to a rural health benefit after the pandemic, without congressional intervention.
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