Physicians are staring down the barrel of a nine percent decrease in CMS payment in 2022 as the 3.75 percent increase to the Physician Fee Schedule expires at the end of the year, with additional cuts coming from the expiring moratorium on the 2 percent Medicare sequester and the 4 percent Medicare payment cut due to the Statutory Pay-As-You-Go Act.
David Kaye, MD, a spine surgeon at Philadelphia-based Rothman Orthopaedic Institute, told Becker's Spine Review about the importance of advocacy on Capitol Hill and two of the most pertinent issues for physicians today.
Dr. Kaye: Spine advocacy today is as important as ever. Two of the current high-priority issues working their way through Congress are the potential cuts to the Medicare Physician Fee Schedule and HR 3173 Improving Seniors Timely Access to Care Act of 2021. Regarding access for senior care, there has been bipartisan support to address cumbersome prior authorization practices and the current bill aims to streamline prior authorization for Medicare Advantage plans.
Regarding the potential cuts, Congress has proposed reducing the conversion factor by 3.75 percent from 2021, offsetting the temporary funding boost Congress authorized with the 2021 Consolidated Appropriations Act in December 2020. Medicare payments for provider services, while only representing a small portion of total healthcare expenditure, are continually targets for cost containment, and although the sustainable growth formula has helped, payments have nonetheless failed to keep up with inflation. Numerous coalitions, including the National Association of Spine Specialists (the advocacy arm of the North American Spine Society) are working to maintain "stability" by reaching out to representatives to retain the 3.75 percent increase to the conversion factor through at least 2022 and 2023. Moving forward, continued advocacy will be needed to encourage Congress to reform the Medicare Physician Fee Schedule.