ACR, medical societies lobby for legislation ensuring 'overdue' E/M rate increases
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The American College of Rheumatology and 60 other health care groups have signed a letter in support of legislation that would ensure evaluation and management rate increases under Medicare without payment cuts to providers during the COVID-19 pandemic.
The bill, H.R. 8505, would implement the CMS Calendar Year 2021 Medicare Physician Fee Schedule final rule as written, allowing for “long overdue” rate increases for E/M services provided by rheumatologists, neurologists and other cognitive specialties, according to an ACR press release. However, key to the bill is a 1-year waiver for budget neutrality adjustments, which would avoid rate cuts to other specialties or physical and occupational therapists.
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“H.R. 8505 is a win-win solution for all medical specialties, and we encourage congressional leaders to swiftly pass this legislation,” David Karp, MD, PhD, president of the ACR, said in the release. “Current E/M reimbursement rates suppress patient access to diagnosis, treatment, and health maintenance at a time when demand for care is increasing. If this dire situation is not addressed as planned in the Medicare Physician Fee Schedule, then patient access to care will continue to decline.”
The bill was introduced in the U.S. House of Representatives in October by Rep. Michael Burgess (R-TX) and Rep. Bobby Rush (D-IL). It has been referred to the House committees on Energy and Commerce, Ways and Means, and Appropriations.
In their letter, addressed to the chairmen and ranking members of the Energy and Commerce and Ways and Means committees, the ACR and other health care groups argued the bill “meets the needs of all stakeholders by allowing CMS to implement the [Medicare Physician Fee Schedule] final rule on schedule and as written, while funding offsets to the reimbursement reductions using funds allotted for provider support during the pandemic crisis.
“The long-overdue increases to patient office visits and other E/M services will not offset the severe financial losses practices that provide these services have experienced during the COVID-19 pandemic,” read the letter, dated Nov. 16. “All clinicians are suffering financially at this time and legislative support related to the pandemic should not exclude primary and cognitive care physicians who are on the front lines of treating patients. We urge Congress to ensure that any legislation to address cuts for certain services resulting from budget neutrality does so narrowly and without distorting relative values and actual payments as determined though the regulatory process which considers public comment and input from physicians.”
Other signatories include the American Academy of Family Physicians, the American Academy of Neurology, the American Gastroenterological Association, the Association for Clinical Oncology, the Endocrine Society, the Society of General Internal Medicine, the Association of Women in Rheumatology and multiple other national and state medical associations.
According to the ACR, CMS in 2018 proposed a code collapse that would have resulted in significant cuts to rheumatology care for Medicare beneficiaries. However, after hearing the concerns raised by the patient and specialty provider community, CMS finalized a new proposal that reflected recommendations from the American Medical Association, the ACR and more than 170 other specialty societies and state medical associations.
When enacted, the new rule will provide updates to Medicare reimbursement for time-intensive health care services, including examinations, disease diagnosis, risk assessments and care coordination, the release said.
“The E/M improvements that will go into effect in January 2021 are critical to the continued delivery of high-quality rheumatology care for millions of Medicare beneficiaries,” Karp said in the release. “Budget neutrality via H.R. 8505 is a fair and reasonable approach to ensure these needed updates are not made at the expense of other specialties.”
Perspective
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David A. McLain, MD, FACP, FACR
The cost of providing medical services through our clinics continues to increase year after year. Unlike our colleagues in other professions, such as dentistry, veterinary medicine, and law, the increased cost of providing the service is of no concern to the reimbursement. In medicine, we have been in a “take it or leave it situation”.
Often the commercial insurers base their reimbursement on the Medicare Physician Fee Schedule and with budget neutrality, rheumatologists have gotten little increase from Medicare for years. In those same years, costs have risen. DXA and X-ray machines have been abandoned as the costs to provide these services is higher than the reimbursement. We have seen a number of our colleagues sell their practices and take the role of an employee.
H.R. 8505 provides some relief with a 16% increase in the Medicare Fee Schedule for 2021 without reduction for budget neutrality. I urge all rheumatologists to visit the ACR Legislative Action Center and send a message to your senators and representative. This only takes 2 minutes: Just enter your name and home address. The site provides text for the message and the contact information for your Congressional representatives based on your address. Click this link to voice your support for enacting the E/M changes: https://www.votervoice.net/iframes/ACR/Campaigns/60493/Respond
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