CMS Chief Calls Radiologist-opposed Medicare Cuts Routine, a Separate Issue From The Pandemic
As radiology and other specialties fight forthcoming cuts to Medicare reimbursement, the head of CMS is calling the reductions routine, and a completely separate issue from the COVID-19 pandemic.
The Centers for Medicare and Medicaid Services dropped its final 2021 Physician Fee Schedule on Tuesday, which includes pay cuts of 10% or more for certain specialties. Dozens of physicians believe the changes are ill-timed, given the challenging economy. However, CMS Administrator Seema Verma labeled this as a routine action that occurs every year, Inside Health Policy reported Monday.
“Every year, we go through this process where we’re making adjustments to the reimbursements, and so every year there are pluses and minuses. So, that’s not necessarily something that’s not routine; that happens all the time,” she told the news site.
Verma believes COVID-19 and modifications to the physician payment schedule are entirely separate matters, with the former already handled by previous federal actions.
“The issues around the pandemic are hopefully short-term and those have been addressed by the provider relief fund. The changes that we are making today, while going into effect, will have a long-term impact on the entire healthcare system,” Verma said.
In the final rule, CMS also noted that it cannot use its public health emergency authority to overturn payment cuts. That’s why a coalition of providers groups including ACR and the RBMA are urging Congress to pass legislation to counteract the changes.
Imaging Groups Push Back Against ‘Arbitrary, Ruinous’ Radiology Cuts in CMS’ 2021 Physician Fee Schedule
By Matt O’Connor | December 2, 2020
A number of top imaging groups are railing against the Centers for Medicare and Medicaid Services’ decision to include reimbursement cuts to radiology in its finalized 2021 Physician Fee Schedule.
Shortly after CMS publicized its rule on Tuesday night, the American College of Radiology and its coalition of more than 70 healthcare organizations pushed back on what they see as “arbitrary” reductions, suggesting patients will ultimately bear the brunt of these cutbacks.
Under the new rule, which begins on Jan. 1, Medicare payment policy changes for office and outpatient visits will result in reimbursement cuts of 10% for certain specialties, including radiology.
“If Congress fails to mitigate these cuts, decreases in Medicare payments will further exacerbate the problems occurring across the country with practices and institution-based providers furloughing or cutting staff and an increasing number closing their doors in response to the COVID-19 pandemic,” the ACR said in its Dec. 1 statement.
ACR President Geraldine McGinty, MD, MBA, called CMS’ move “disappointing” in a tweet sent yesterday.
On Wednesday morning, the Medical Imaging & Technology Alliance said it strongly opposes CMS’ decision, labeling the specialty cuts as “ruinous.” Executive Director of MITA, Patrick Hope, also underscored the detrimental impact such reductions would inflict as radiology departments grapple with the ongoing pandemic.
Meanwhile, the American Society of Nuclear Cardiology noted the new payment policies would give a 1% bump to cardiologists, on average, but would significantly impact those who rely on imaging to diagnose and manage their patients. It also urged Congress to intervene on behalf of physicians.
The ACR, MITA and ASNC are all part of a coalition representing more than 1 million physician and nonphysician providers across the U.S., urging Congress to pass the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020.”
“Our organizations stand united in highlighting that in the end, patients will suffer the most from implementation of these detrimental cuts,” ACR said in its statement on Tuesday.
To read more, go to Health Imaging.
Physician Fee-schedule Changes Could Upend Compensation, Experts Say
By Michael Brady | November 30, 2020
Providers should evaluate their operations and compensation plans to get ready for CMS’ looming 2021 physician fee schedule, experts said.
The proposed rule would lower the fee schedule’s conversion factor from $36.09 to $32.26, a decrease of $3.83 or 10.6%. It would also make several changes to evaluation and management services and codes, including increases in their relative value and changes to coding criteria. Those moves would probably help clinicians that deliver a lot of those services, but proceduralists will see their revenues decline if CMS doesn’t make significant changes in its final rule.
The proposed changes are budget neutral for the Medicare program. But some health systems and medical groups could suffer financially if their revenues decline and compensation costs rise at the same time.
“It’s putting us in a really precarious situation,” HSHS Medical Group CEO Melinda Clark said.
It’s tough for providers to predict how all the changes to primary and specialty care payments will shake out when nobody knows how the coronavirus outbreak will affect their practices over the next two quarters, said Dr. James Bock, chief physician executive at HSHS Medical Group. That makes it “almost impossible” for medical groups to budget in the short- or intermediate-term, he said.
CMS pushed back its final physician fee schedule by a month to tackle urgent problems caused by COVID-19—the agency will make it available this week. The rule should take effect on Jan. 1, giving providers just a month to respond. That could be a challenge for healthcare executives during a busy and complicated holiday season, especially when many provider groups are short-staffed thanks to pandemic-induced financial challenges.
To read more, go to Modern Healthcare.
4 Healthcare Issues to Watch as Congress Faces a Funding Deadline in December
By Rachel Cohrs | November 27, 2020
Congress is working to avert a government shutdown on Dec. 11, and providers are lobbying to ensure several of their healthcare policy priorities are addressed.
When lawmakers most recently extended the government funding deadline in September, they included one of providers’ top priorities by relaxing repayment terms for COVID-19 Medicare loans. Providers see several opportunities for getting other key policies included in Congress’ next must-pass bill.
Extend Medicare sequester suspension
Congress suspended sequestration cuts to Medicare in its third and largest COVID-19 stimulus package in March. While some policies that gave relief to providers are tied to the HHS secretary’s public health emergency declaration, a suspension of Medicare sequestration cuts expires at the end of 2020. Hospitals have argued that funds shouldn’t be cut now, as providers are simultaneously bracing for more surges and preparing to distribute vaccines in the coming months.
Physician fee schedule cuts Medicare pay cuts for specialty physicians are set to go into effect Jan. 1, and providers are scrambling to head them off. Providers are pushing for Congress to waive budget-neutrality requirements so primary-care physicians can still receive boosted payments without requiring corresponding cuts for specialty physicians. A Senate GOP aide said it’s unlikely lawmakers will grant a full budget-neutrality waiver, as they would have to tack more cost-saving measures onto the package to pay for the changes. CMS could still make changes when it finalizes the policy, but the aide said lawmakers are skeptical CMS will address the issue.
Healthcare extenders Funding for several Medicare and Medicaid programs also expires on Dec. 11, including a suspension of cuts to Medicaid disproportionate-share hospital payments. Ongoing funding for community health centers is also at stake, and it remains to be seen how long Congress will push the funding deadline. The package has been repeatedly bumped during 2020 as lawmakers had hoped to build consensus on reform to prescription drug costs and surprise medical bills, but legislation on both issues has stalled. The new extension date could set the pace for healthcare policymaking in 2021.
Stimulus bill Lawmakers have failed to reach a compromise on another comprehensive COVID-19 relief package for months, but important benefits are expiring in December as portions of the country reinstate pandemic restrictions. President-elect Joe Biden has met with Democratic congressional leaders in recent days, which could change the political dynamic. If lawmakers aren’t able to reach agreement in 2020, a deal will likely have to wait until after results are tabulated in two Georgia Senate runoffs scheduled for early January that will determine control of the upper chamber. It’s unclear which policies both sides could agree on, but a deal could mean more funding for COVID-19 testing and tracing, vaccine distribution, and state and local governments.
To read more, go to Modern Healthcare.
HHS Overhauls Key Healthcare Fraud Laws to Advance Value-Based Care
By Jacqueline LaPointe | November 24, 2020
After years of debate, HHS agencies have made changes to two major healthcare fraud, waste, and abuse laws that providers have said get in the way of value-based care progress.
Late last week, CMS and OIG released final rules that will provide new exceptions to the Physician Self-Referral Law, otherwise known as the Stark Law, and the Anti-Kickback Statute for providers participating in value-based care models.
Specifically, the final rule from CMS created new, permanent exceptions for value-based providers under the Stark Law. Meanwhile, OIG’s final rule modified four existing Anti-Kickback Statute safe harbors and codifies a new exception under the Beneficiary Inducements Civil Monetary Penalty (CMP) law provision.
Together, HHS intends for the new regulations to support provider efforts to implement value-based care models without the fear of violating healthcare fraud, waste, and abuse laws.
“[W]e’ve completed historic reforms to regulations that have stood in the way of creativity and innovation by American healthcare providers for far too long,” HHS Secretary Alex Azar said in an announcement. “These new regulatory reforms will mean better care, including innovative arrangements with digital technology that may help patients receive care during the COVID-19 pandemic.”
The rules are both part of HHS’ Regulatory Spring to Coordinated Care, which is an initiative that examines federal regulations that have potentially stymied provider efforts that would have otherwise advanced the transition to value-based care and improved care coordination.
Additionally, the CMS final rule “clarifies and modifies existing policies to ease unnecessary regulatory burden on physicians and other healthcare providers while reinforcing the physician self-referral…goal of protecting patients from unnecessary services and being steered to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest,” according to HHS.
To read more, go to Revcycle Intelligence.