Providers push for Medicare pay boost

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Doctors oppose looming Medicare cuts as they continue to grapple with the COVID-19 pandemic.

The 2022 Medicare physician fee schedule would level an across-the-board 3.75% pay raise implemented in the 2021 fiscal year. Typically, increases for certain provider groups would come at the expense of other specialties to balance the budget. But Congress temporarily recalibrated the budget-neutral framework considering the pandemic.

CMS should reconsider budget neutrality and the associated pay cuts, the American Medical Association recommended.

“We are deeply concerned about the growing financial instability of physician practices due to the severe reduction in revenue caused by the COVID-19 public health emergency. The looming payment cuts facing physician practices at the end of this year, including cuts due to budget neutrality, must be addressed to ensure that practices can remain fiscally viable,” AMA CEO Dr. James Madara wrote to federal regulators Monday, when the comment period for the proposed rule closed.

Provider groups were generally supportive of CMS’ plan to allow Medicare providers to offer certain services via telehealth until the end of 2023. Some pushed to permanently codify those changes.

CMS, for instance, plans to permanently reimburse audio-only communication for mental health services even after the pandemic subsides.

“During the pandemic, a number of our beneficiaries were only able to access care via audio-only communications technology,” Caleb Wallace, vice president of health policy and regulatory affairs at UPMC Health Plan, wrote. “This was especially true for some of our most vulnerable members, who either did not own a smartphone, lacked access to a computer or the internet, lived in a rural area with inadequate broadband access or lacked familiarity with technology and requisite applications to readily launch and participate in a two-way, real time, audio/video telehealth visit.”

Providers would have to coordinate an in-person mental health visit within six months after the audio consultation, CMS proposed. That requirement would impede access, provider groups said. CMS would also require an in-person checkup with a physician or practitioner within six months prior to the first telepsychiatry visit.

CMS excluded certain services from the telehealth proposal, including physical therapy.

“The expansion of telehealth payment and practice policies to allow physical therapists to provide services via telehealth during the public health emergency has demonstrated that many needs can be effectively met via the use of technology and that patients can have improved access to skilled care by leveraging these resources,” the American Physical Therapy Association wrote.

The physician fee schedule always sparks a debate. Medicare payment rates haven’t kept pace with inflation, providers argue. Industry observers counter that their rates were already too high.

CMS’ proposal aligns with the Medicare Access and CHIP Reauthorization Act of 2015, which didn’t increase the Medicare fee schedule base payment rate for 2022. The Medicare Payment Advisory Commission, which advises Congress on Medicare issues, concluded in its March report that total payments to clinicians were adequate.

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