Medicare pay cuts loom as Congress contrarily considers new benefits

As lawmakers in Washington debate a “human infrastructure” package and whether to expand Medicare to include dental, vision, and hearing benefits, vitally important and timely work has been undertaken to prevent looming cuts to the program as it currently exists. Most notably for clinical urologists, the AACU is pushing back against a 3.75% reduction to Medicare payments that was proposed for 2022. Coupled with cuts that had previously been delayed, physicians face a 9.75% Medicare pay cut starting January 1.

The proposed 2022 Medicare Physician Fee Schedule “paints a bleak picture for patients” according to United Specialists for Patient Access (USPA), a coalition of providers involved in office-based specialty care.¹ The main driver of cuts in the 2022 proposal is a change in how costs directly assumed by a physician while providing a service (ie, practice expenses) are calculated. Year-to-year, these costs must be “budget neutral.” This year, because the Centers for Medicare & Medicaid Services (CMS) proposes to increase the clinical labor cost component of practice expenses, an equal offset must be generated by reductions to medical supplies and equipment costs. In practice, AACU President Elliott Lieberman, MD, warns this would result in significantly reduced “reimbursement of many office- and hospital-based procedures performed by urologists, such as prostatic urethral lift, transurethral destruction of prostate tissue by radiofrequency-generated water vapor thermotherapy, and other minimally invasive prostate therapies.”²

Over 70 members of Congress led by UROPAC-supported Rep. Bobby Rush (D-IL) and Rep. Gus Bilirakis (R-FL) signed a letter urging CMS to postpone the changes to clinical labor costs.³ The lawmakers expressed concern that “budget neutrality” is a driver of health system consolidation that will ultimately result in increased costs to the Medicare program. Moreover, they called for fundamental reform to the Medicare physician fee schedule to address another imminent pay cut that has been the focus of recent AACU advocacy efforts. In several calls to action, the AACU urged urologists to support congressional action to extend relief from an earlier 3.75% physician fee schedule cutback as well as the 2% Medicare sequester and an up to 4% Medicare pay cut triggered by the American Rescue Plan.⁴

Other aspects of the 2022 Medicare proposal were warmly received by physicians. The AACU, for one, voiced support for continuing to base evaluation and management services based on either the total time spent with patients during their visit or the medical decision-making associated with a patient visit. On the telehealth front, CMS plans to retain all services previously added to the Medicare telehealth services list on a temporary basis until the end of calendar year 2023. The agency also indicated support for making permanent the waivers Congress issued addressing payment parity, originating site, and geographic site. The proposal notes, however, that maintaining that flexibility, as well as coverage for audio-only services, depends on congressional action.

With a temporary payment boost set to expire at the end of the year, Medicare reimbursements face a 3.75% decrease. When you add another 2% with the Medicare sequester and additional cuts of up to 4% under the American Rescue Plan, urologists face a nearly 10% decrease in Medicare reimbursement. Instead of stopping these cuts, Congress is considering adding benefits that will cost an additional $358 billion, according to a 2019 congressional report. Absent urgent congressional action, the pace of health care industry consolidation will quicken and patients will wind up being cared for at higher cost settings, further threatening the viability of the Medicare program itself. All is not lost, however…amidst this absurdity, urologists are providing high-quality, cost-efficient, and patient-centered care.

Based on a partnership with Urology Times®, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

References

1. Garcia M. Op-Ed: CMS must eliminate cuts and reform the Physician Fee Schedule. United Specialists for Patient Access. Accessed October 5, 2021. https://www.uspaccess.org/oped-drmarkgarcia

2. Lieberman E. Letter RE: File Code CMS–1751–P. Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-Payment Medical Review Requirements. September 13, 2021. Accessed October 5, 2021. https://aacuweb.org/docs/news/20210913-cy2022-mpfs-comment-letter.aspx

3. Rush BL, Bilirakis GM, DeFazio PA, et al. Letter RE: CY 2022 Payment Policies under the Physician Fee Schedule. September 13, 2021. Accessed October 5, 2021. https://rush.house.gov/sites/evo-subsites/rush.house.gov/files/evo-media-document/CMS%20Letter%202021%20PFS%20Rule.pdf

4. Looming threats to Medicare could affect patient access to care. Patients Action Network. Accessed October 5, 2021. https://patientsactionnetwork.com/action-center?vvsrc=%2fCampaigns%2f87837%2fRespond