ACR commends reimbursement boost for cognitive care in 2021 Medicare Fee Schedule
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The American College of Rheumatology has praised CMS for approving “long awaited” updates to cognitive care reimbursements for Medicare, increasing the amount for evaluation and management services.
In a press release, the ACR stated that the update, part of CMS’ 2021 Medicare Physician Fee Schedule final rule, clears the way for “much needed” increases in Medicare reimbursement for E/M services, including examinations, disease diagnosis, risk assessments and care coordination.
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“For many years, Medicare reimbursement did not adequately reflect the time and skill required to provide high-quality cognitive care, including rheumatology care,” David Karp, MD, PhD, president of the ACR, said in a press release. “These updates are critical to the future of the rheumatology specialty and the continued delivery of high-quality rheumatology care for millions of Medicare beneficiaries.”
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 concerns and recommendations from more than 170 medical groups and specialty societies, including the ACR and the American Medical Association, CMS reversed course, and later drafted and finalized the current update.
The reimbursement increases take effect Jan. 1.
“These E/M improvements are the result of years of advocacy by rheumatologists and patients that educated policymakers about the importance of time spent with patients for chronic disease management,” Blair Solow, MD, chair of the ACR’s Government Affairs Committee, said in the release. “We commend CMS for recognizing the value of the care provided by rheumatologists and rheumatology health professionals.”
However, not all issues related to the fee schedule have been settled. To ensure that the E/M rate increases do not result in cuts to other medical specialties, such as physical and occupational therapists, the ACR is calling on Congress to pass legislation in the House of Representatives that would waive budget neutrality adjustments for 1 year. The bill, H.R. 8505, 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.
“Budget neutrality via H.R. 8505 is a fair and reasonable approach to ensure needed cognitive care updates are not made at the expense of other specialties,” Solow said in the release. “We encourage congressional leaders to swiftly pass this legislation.”
Perspective
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Michael Schweitz, MD
Key improvements in the relative values for office visits and new payment for complex care will result in an overall increase of 15% in Medicare payments to rheumatologists (i.e., the rheumatology “pool” of Medicare dollars) beginning January 1, 2021. Medicare’s long overdue recognition of the importance of the cognitive process in providing high quality medical care is a welcome change, and rheumatologists appreciate CMS’ commitment to appropriately compensating cognitive-oriented physicians.
Many rheumatologists, however, have expressed confusion by the forthcoming Medicare pay raise as the just released physician fee schedule reflects a $32.4085 conversion factor, representing a 10.2% cut. How does this all jive? Remember, the Medicare Physician Fee Schedule is “budget neutral,” so the aforementioned increases are being “paid for” through a sharp reduction in the conversion factor. And, because rheumatologists primarily deliver E/M services in the office setting, we come out ahead.
As you can imagine, some specialties are disproportionality impacted – infectious diseases, pathology and emergency medicine, to name a few. The House of Medicine has asked Congress to intervene and mitigate the pay cut, particularly given the substantial economic hardships all physicians face due to the COVID-19 pandemic. Two legislative approaches have been introduced in the House and are supported by the AMA and the overwhelming majority of medical specialty societies, including the Coalition of State Rheumatology Organizations.
Either option would further improve Medicare reimbursements for rheumatology while holding others harmless from steep reductions, although these options are temporary and would require Congressional invervention again in the future.
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