The Centers for Medicare and Medicaid Services (CMS) on Tuesday released the final 2021 Medicare Physician Payment Schedule. The California Medical Association (CMA) and the American Medical Association (AMA) are currently reviewing the rule and will release a detailed summary shortly.

Budget Neutrality Impact

While there are many positive changes in the new payment policies for 2021—including improvements for maternity care and much-needed payment increases for physicians delivering primary and complex office-based care to some of our nation’s most vulnerable patients—CMS does not offer any relief from the budget neutrality cuts in the final rule.

CMS operates under a statutory “budget neutrality” rule that requires any increases in Medicare payments 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.

Because of the budget neutrality and other payment policy changes, redistributions will be significant, with family medicine increasing by 13% and many specialties that do not perform office visits decreasing by 9% or more. (See this table for impacts by specialty.)

Cuts of this magnitude are problematic for all services, but we are extremely concerned that these cuts will directly impact care to COVID-19 patients, as payments for hospital visits, critical care visits, nursing home visits, and home visits are among those being slashed.

Congressmen Ami Bera, M.D., (D-CA) and Larry Bucshon, M.D., (R-IN) have introduced a bill – H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020” – to stop the looming Medicare payment cuts while protecting the primary care payment increases. CMA is urging physicians to contact their Members of Congress to cosponsor H.R. 8702.

Telehealth

Because CMS does not have the regulatory authority,  the final rule does not make permanent the expansion to telehealth services authorized during the public health emergency. The rule does, however, add more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the pandemic. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services and critical care services. Current Medicare laws only allow telehealth services  to patients in  rural areas and patients cannot receive those services in their homes.   While CMS waived those laws during the COVID-19 public health emergency, only Congress can change the law. Several bills have been introduced to make the waivers permanent.  In the meantime, CMS has commissioned a study of the telehealth flexibilities provided during the COVID-19 public health emergency to explore new opportunities for services where telehealth, virtual care supervision and remote monitoring can be used to more efficiently bring care to patients.

Scope

The final rule also makes permanent changes implemented under the federal public health emergency that would allow certain non-physician practitioners – including nurse practitioners and physician assistants – to supervise the administration of diagnostic tests within their state scope of practice and applicable state laws. Although California law would not allow expanded authority to any category of nurse practitioner to supervise diagnostic procedures, CMA believes that permanent implementation of the rule will cause confusion and harm patients. Nurse practitioners  do not have the education and training to perform all diagnostic procedures, as broadly defined in the rule, or to provide clinical supervision for non-physician practitioners performing diagnostic procedures. 

For more information:

• CMS Press Release
• CMS 2021 Medicare Physician Fee Schedule Fact Sheet
• CMS 2021 Quality Payment Program Fact Sheet (automatic download)
• CMS 2021 Medicare Physician Fee Schedule Final Rule Text
• Impact by Specialty