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The final 2021 Medicare Physician Fee Schedule (MPFS) issued today by the Centers for Medicare & Medicaid Services (CMS) failed to provide relief from a significant shift in physician and non-physician payments expected to take effect on January 1, 2021. Thousands of comments submitted by providers, patients, and Members of Congress highlighted the importance of mitigating payment cuts associated with budget neutrality requirements triggered by higher payment and modified reporting requirements for evaluation and management (E/M) services.
Due to CMS’s unresponsiveness to address these concerns, organizations representing more than 1 million physicians and nonphysician health care providers across the United States urge Congress to include legislation in any year-end package to prevent these arbitrary Medicare cuts in order to protect patient access to medically necessary services.
In late 2019, CMS announced new Medicare payment policies for office and outpatient visits — also known as E/M services — billed by physicians and some nonphysician providers. These new payment policies will result in cuts of up to 10 percent or more for certain specialties. Due to Medicare’s budget-neutrality requirements, physician, nonphysician, and institutional providers billing under the PFS will experience substantial payment reductions to offset payment increases to physicians and other providers who primarily deliver office-based services. These cuts will be devastating to an already struggling health care system and may lead to reduced access to care for older Americans and Americans with disabilities.
Similar concerns were relayed to CMS in a September 24, 2020 letter signed by 161 bipartisan members of the U.S. House of Representatives. However, the recent publication of the Final Rule confirmed CMS’ intent to move forward with implementation of the E/M changes without recognition that these payment reductions will have a net negative impact on the Medicare program. As a result, our organizations are calling on Congress to include H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 , in a forthcoming year-end legislative package. This critical legislation, supported by more than 300 national, regional, state and local organizations—including all 50 states, the District of Columbia and Puerto Rico—provides a necessary reprieve for a broad array of physicians and non-physician health care providers facing substantial payment reductions in the coming months, while also allowing payment increases to go forward for those who provide E/M services to Medicare beneficiaries in a stand-alone office visit or outpatient setting.
