MGMA, ACS, ACEP Pan 2021 Physician Fee Schedule

The Medicare physician fee schedule final rule was released less than two weeks after the Trump administration announced changes to the Physician Self-Referral Law, also known as "Stark Law."

Physicians groups panned the 2021 Medicare Physician Fee Schedule final rule released by the Centers for Medicare & Medicaid Services (CMS) Tuesday afternoon.

Though there will be an increase in payment for office/outpatient face-to-face evaluation and management (E/M) visits starting in 2021, the final calendar year (CY) 2021 physician fee schedule conversion factor will be $32.41, down from $36.09 during CY 2020.

"This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care," CMS Administrator Seema Verma said in a statement. "In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses."

The final rule was released less than two weeks after the Trump administration announced changes to the Physician Self-Referral Law, also known as "Stark Law."

Over the summer, several medical groups and physician associations expressed their frustration with the Trump administration's proposed physician fee schedule for 2021. Many of those same organizations revived concerns Tuesday evening.

"While MGMA is appreciative of streamlined documentation policies and payment increases to physicians that primarily deliver office/outpatient E/M services, the 10% decrease to the conversion factor and resulting reimbursement cuts to many specialties is deeply troubling during a time when COVID-19 cases are skyrocketing and practices are scrambling to stay financially viable," Anders Gilberg, senior vice president of government affairs at MGMA, said in a statement. "We are disappointed that CMS decided to not provide the stability that physician practices require to meet patient needs during this unprecedented public health emergency."

The American College of Surgeons said the policy decision would "further destabilize" the nation's healthcare system during the ongoing COVID-19 pandemic.

"If implemented, the Medicare Physician Fee Schedule will have drastic consequences for Medicare patients seeking surgical services," David B. Hoyt, MD, FACS, executive director of ACS, said in a statement. "Without congressional intervention, these policies will result in significant cuts to physician payment for most surgical services delivered to Medicare patients, exacerbate surgical workforce shortages, and worsen the crisis of rural hospital closures."

Similarly, the American College of Emergency Physicians (ACEP) stated Tuesday evening that it was "disappointed and dismayed" by the final rule.

"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 ACEP, said in a statement. "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 organization urged Congress to pass the "Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020," a bill that MGMA said, "holds physicians harmless." The bipartisan legislation would hold physicians' reimbursement at 2020 Medicare levels for the next two years.

"The bill introduced by Reps. Bera and Bucshon is a win for patients and a win for physicians, and I urge all members of Congress to support it," Ronald Dalman, MD, DFSVS, president of the Society for Vascular Surgery, said in a letter. "Our health
care system is under extraordinary pressure, and now is the time for Congress to act and protect our patients."

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.