2021 Medicare Physician Fee Schedule Causes Concerns

The latest analysis of the new 2021 Medicare Physician Fee Schedule is finding more ways for radiologists to detest the new proposal. There are several valid reasons to do so.

Consulting company Healthcare Administrative Partners shared a deep dive recently, highlighting substantial cuts of doc payments in the coming year.

While the numbers are already out in the open, a Pennsylvania-based HAP discovered the impact of high-volume radiology procedures, which led to 18%, drops in 2021. The slashes also follow the addition of a pay boost to evaluate and manage services, which, in turn, necessarily balances the budget, which advocates believe would come from physicians and radiologists.

VP of HAP client services, Sandy Coffta, writes, “Many specialties, including radiology, will see a significant cut in Medicare reimbursement in 2021 if the MPFS Proposed Rule is applied without a change to the budget neutrality requirement in the law.” She also adds, “The proposed rule is subject to comment from the public and interested organizations that will potentially modify its proposals.”

Coffta along with her colleagues analyzed different parameters using the payment database to calculate the effect on some of the most common procedures. In her report, she noted that there would be a drop of 10%, if not more, in the hospital professional payment component for extracranial bilateral study, with the help of a duplex Doppler, to a new high of 18% CT of thorax without any dye. Cuts would be within the range of 11% to 12%.

Meanwhile, the reduction range is expected to be much higher for providers at separate imaging centers, with just about 1% cuts for specific x-rays and up to 15% cuts for CT. Besides, the cost of MRI could drop by 8%, whereas ultrasound could be 7% less expensive. The overall cuts may be as low as 11%, according to Coffta’s estimates.

Concerns With Medicare Physician Fee Schedule Rule 2021

Provider groups have some serious concerns with the proposed Medicare Physician Fee Schedule 2021 rules. It could worsen physicians’ existing financial challenges due to the Covid-19 situation, which includes a lack of sustainable practice revenues and proper telehealth reimbursement.

The new rule was released in August 2020, proposing several changes such as steep payment slashes for specific specialties, innovative reporting systems, and some telehealth coverage changes. Provider groups, however, only saw the major challenges these changes could bring along. They even called on the CMS and ensured they reconsider payment changes to support those provider groups that saw a decrease in practice revenue by 50%, on an average, before the pandemic began.

Jerry Penso, MD, MBA, the President of AMGA the CEO said, “More than anything right now, our members need certainty. CMS’ plan, unfortunately, would add yet another change into a system that is dealing with an upheaval in how care is provided.”

In this regard, AGMA and many other provider groups made some recommendations as follows:

#1: Exclude Budget Neutrality Slashes

One of the main things proposed in the new rule change is a rise in RVUs (Relative Value Units) and reimbursement, mainly for primary healthcare services and for chronic disease management. However, the rule further includes payment conversion factor cuts from $36.09 to $32.26. This reduction would ensure budget neutrality adjustments for any changes in the RVUs as per law.

Although providers support the rise of investments in chronic disease management and primary care, reductions would lead to a 5.5% slash in physician payment. Thus, it brings down the total cuts to approximately 11% after considering other proposals, according to American Medical Association reports.

#2: Magnify Telehealth Coverage

Provider groups urged the CMS to consider strengthening proposals concerning telehealth coverage in their final report of the Medicare Physician Fee Schedule 2021.

The proposed rules include different policies to magnify overall telehealth coverage, which includes adding eight codes to the list of Category 1 telehealth services and create a new Category 3 list to provide temporary coverage growth.

In the case of this proposal, the consensus is that all the steps are in the proper direction. Nonetheless, provider groups want permanent flexibilities as telehealth services are now turned on due to PHE (public health emergency).

The American Medical Association reports, “CMS telehealth policy changes during the PHE enabled patients to get much-needed care. Patients and physicians now understand the value and importance of telehealth. Consequently, the AMA urges CMS to continue to strengthen telehealth policies: making permanent several telehealth services, removing geographic and site of service barriers, and continuing to cover services through the end of the year following the year in which the PHE ends. These services should include audio-only visits.”

#3: Reconsider Changes In Quality Reporting

Changes in quality reporting concerning Quality Payment Program and similar value-based reimbursement models have been an important concern for the leading provider groups. Specifically, provider groups vehemently opposed APM Scoring Standard replacement with a new model called Alternative Payment Model Performance Pathway (APP).

CMS proposal reads the APP should facilitate transitioning from Merit-Based Incentive Payment System (MIPS) to Alternative Payment Models (APMs). To ensure smooth operations, the agency also proposed to use a separate standard quality measure, in smaller quantities in 2021.

However, switching to APP would not necessarily improve quality of care, as per value-based provider groups like the National Association of ACOs (NAACOS), Association of American Medical Colleges, and Medical Group Management Association (MGMA). They commended CMS to reschedule such noteworthy modifications to quality reports at the time of this pandemic.

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