Final CMS rule lowers Medicare payments to emergency physicians

The American College of Emergency Physicians announced that it is “disappointed and dismayed” by CMS’s final 2021 Medicare physician fee schedule rule, which will lead to reduced reimbursement for emergency medicine services.

“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,” Mark Rosenberg, DO, MBA, FACEP, president of the American College of Emergency Physicians (ACEP), said in a press release. “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.”

The reduction stems from the legally required budget neutrality adjustment — designed to account for changes in relative value units for work and expenses — which led the conversion factor for relative value units to decrease from $36.09 in 2020 to $32.41 in 2021.

For emergency physicians, CMS estimated that the decreased conversion factor would lower payments by 6% overall.

When CMS initially announced the 2021 plan over the summer, the ACEP provided the agency with specific policy recommendations to help completely avoid or mitigate the reduction. These recommendations included that CMS and HHS use their authority under the COVID-19 public health emergency to waive the budget neutrality requirement for 2021 and use a 20% professional service claims-based payment adjustment during the public health emergency to account for additional costs to patient care caused by the COVID-19 pandemic.

ACEP said that none of their policy recommendations were incorporated in the final 2021 plan.

According to the ACEP, this final payment plan will affect other payers beyond Medicare — including those with private insurance — because these insurers often structure payments based on Medicare rates.

ACEP and other organizations support the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020,” which would temporarily maintain physicians’ reimbursement for Medicare at 2020 levels over the next 2 years if they were scheduled to receive payment cuts during that time.

“Emergency physicians have courageously faced a global pandemic that has shaken our health care system to its core, unwavering in their commitment to their patients despite potentially deadly exposure to the disease for themselves and their families,” Rosenberg said. “Congress must act now in order for them to continue playing this vital role in our communities.”

References:

• CMS. Final policy, payment, and quality provisions changes to the Medicare physician fee schedule for calendar year 2021. https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1. Accessed Dec. 2, 2020.
• CMS. PFS final rule. https://www.cms.gov/files/document/12120-pfs-final-rule.pdf. Accessed Dec. 2, 2020.
• ACEP. ACEP responds to finalized 2021 physician fee schedule cuts. https://www.emergencyphysicians.org/press-releases/2020/12-1-20-acep-responds-to-finalized-2021-physician-fee-schedule-cuts. Accessed Dec. 2, 2020.
• ACEP. Fact sheet: ACEP’s response to major Medicare payment rule for calendar year (CY) 2021. https://www.acep.org/globalassets/new-pdfs/advocacy/cy-2021-pfs-and-qpp-proposed-rule-acep-responses-summary.pdf. Accessed Dec. 2, 2020.