Health Policy

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Physician Fee Cuts Averted, But Another Challenge Looms

As 2020 drew to a close, Congress heard the grassroots calls of ASNC members and others throughout the house of medicine and swooped in with legislation to avert an across-the-board Medicare physician fee cut. Given the happy ending, it’s tempting to put the whole chapter behind us and forget about it. That would be a mistake. Here we explain why.
First, the meaningful results: 
The end-of-year legislation blunted the 10.2 percent cut to the Medicare physician fee schedule conversion factor by: 
  • Adding $3 billion to the physician fee schedule in 2021, leading to a 3.75 percent pay raise across specialties. As a result, cardiology payments will increase by an average of 3 percent. Without congressional action, the average increase would have been 1 percent with imaging services taking a significant hit. 
  • Suspending payments for the new add-on evaluation and management (E/M) code G2211 for three years (through December 2023). G2211 was created to account for visit complexity inherent in E/M visits.
Congress also extended the moratorium on the 2 percent Medicare sequester until March 31, 2021. Note: ASNC is asking Congress to further extend this moratorium through the duration of the COVID-19 public health emergency. Stay tuned for details. 
Crisis averted? Not really. More like postponed. 
The threat to physicians’ pay was caused by budget-neutrality rules. By law, neither increases nor decreases in RVUs may cause annual Medicare expenditures to differ by more than $20 million. If this threshold is exceeded, CMS must make adjustments – and, in the case of E/M changes, a cut to the conversion factor – to preserve budget neutrality.
Because the budget-neutrality law remains in effect, the threat of cuts persists for next year and beyond. 
The position of some policymakers, including members of the Medicare Payment Advisory Commission (MedPAC), is that a budget-neutral system improves payment adequacy. MedPAC’s position is that a broad range of services – particularly for imaging –  are overvalued. Support for this zero-sum payment system creates a persistent threat to nuclear cardiology and other specialties.
The question before us: What can nuclear cardiologists and ASNC do? 
  • As a society and individually, we need to tell nuclear cardiology’s story and promote its value.
  • We must convince members of Congress and other policymakers of the shortcomings of current physician payment policies.
  • Collaboration is key. The medical community must work toward more balanced payment policies that reward primary care providers without penalizing specialists. 
ASNC’s Health Policy Committee is moving forward with all of these efforts and will keep you informed of our progress as well as the specific ways you can help.  

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