November 17, 2020
Area(s) of Interest: Advocacy
Congressmen Ami Bera, M.D., (D-CA) and Larry Bucshon, M.D., (R-IN) have introduced a bill to stop the looming Medicare payment cuts while protecting the primary care payment increases of the forthcoming Medicare physician payment rule. The bill – H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020” – was drafted in response to the anticipated impact of the 2021 Medicare physician payment rule, scheduled to be released around Dec. 1, which will cause substantial payment cuts to some physicians. The California Medical Association (CMA) is urging physicians to contact their Members of Congress to cosponsor H.R. 8702.
While the changes in the proposed rule would provide long overdue and much-needed payment increases for physicians delivering primary care and others who primarily provide evaluation and management (E/M) services, the law requires corresponding payment cuts.
The Centers for Medicare and Medicaid Services (CMS) operates under a statutory “budget neutrality” rule that requires any increases in Medicare payments for these office visits to be offset by corresponding decreases. As a result, many physicians now face substantial cuts beginning on January 1, 2021, if Congress does not act before the end of the year.
In the proposed rule, CMS estimated the impacts on specialties to range between -11% and +17%, depending on the mix of services provided.
CMA, the American Medical Association (AMA), and a coalition of organizations representing physicians and allied health professionals sent a letter to Congressional leadership expressing support for H.R. 8702.
CMA, AMA and the rest of organized medicine have been urging Congress to waive the budget neutrality requirement, or to at least postpone it during the COVID-19 pandemic, given the pandemic’s already severe impact on practice revenues. However, due to the budget impact and Congress’ concerns about setting a precedent of legislative intervention into statutory budget neutrality requirements, a total waiver is no longer being discussed.
H.R. 8702 would effectively freeze payments at 2020 rates for services scheduled to be cut in 2021 for a period of two years, while allowing the planned E/M payment increases to take place as scheduled. It also allows physicians billing office visits without the new GPC1X add-on code for complex cases to avert payment cuts. At the end of the two-year reprieve, the full budget neutrality adjustment would take effect unless Congress enacts a longer-term solution.
Importantly, according to the AMA analysis, all specialties will benefit from higher average payments under H.R. 8702. No specialty would experience a negative impact below 0% (as opposed to a cut of 11% under current law) and specialties anticipating total Medicare payment increases in 2021 will see additional increases. The legislation is broadly supported by physician organizations.
The pandemic has hit all specialties hard, and there is no question that payment reductions in a program as important as Medicare threaten practice viability and must be stopped. According to a recent CMA survey, physician practice revenue is still down by 40% and COVID-19 related practice costs are up 14%. CMA supports H.R. 8702 because it is the best compromise under current circumstances, stopping very ill-timed Medicare payment cuts while allowing scheduled payment increases to move forward and protecting access to care during the pandemic and beyond.
Please contact your Member of Congress and ask them to support and co-sponsor H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act,” today!