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ACP Voices Support for Parts of Medicare Physician Fee Schedule and Hospital Outpatient Payment Rule

Advocate Masthead

Dec. 17, 2021 (ACP) – As 2021 draws to a close, Congress has just passed legislation that averts cuts to physician payments that would have produced a combined 9.75% reduction for 2022.

The cuts were averted by passage of the Protecting Medicare and American Farmers from Sequester Cuts Act.

“This piece of legislation suspends the large portion of these cuts, for now, and while ACP supports the legislation, we continue to advocate for long-term solutions to address the challenges with the Medicare payment policy, especially budget neutrality,” said Dejaih Johnson, an ACP governmental affairs and public policy associate.

With the payment cuts averted, at least temporarily, ACP has been focusing on providing additional recommendations to the Centers for Medicare and Medicaid Services (CMS) about other aspects of Medicare payments.

In further comments sent to CMS about the final 2022 Medicare Physician Fee Schedule, ACP detailed a set of top priorities for improvements that would help support and improve the practice of internal medicine.

Included in those recommendations, CMS is now paying for audio-only evaluation and management (E/M) services at a rate equal to in-office and video visits, and ACP wants this to continue even after the end of the public health emergency. “We continue to believe this coverage should extend at least to the end of 2023 and that CMS should maintain pay parity between telephone E/M claims and in-person E/M visits and between all telehealth and in-person visits even after the public health emergency is lifted,” Johnson said.

Not doing so would only worsen the digital divide as parts of the country struggle with broadband connectivity and smartphone capabilities that support video visits, particularly in rural and economically disadvantaged communities. “Some patients remain uncomfortable with video visit technology,” said Johnson. “ACP encouraged CMS to allow telephone E/M services to support these communities in their efforts to care for patients.”

ACP is also urging CMS to make coding and payment available for time spent by physicians providing counseling services to patients who are seeking to mitigate their risk for COVID-19 infection, Johnson said.

In addition, ACP has voiced support for the CMS plan to phase in the implementation of the clinical labor pricing update. Clinical labor pricing is used to calculate the practice expense part of Medicare physician payment rates to account for the cost of staff salaries and benefits, and CMS had not updated it in almost 20 years. Now, health care professionals will receive higher payments during the next four years for certain tasks. “ACP remains hopeful that internal medicine physicians who rely primarily on clinical labor rather than supply or equipment will receive relative increases that are appropriately commensurate with their costs,” said Johnson.

Hospital Outpatient Prospective Payment System Update

CMS has finalized Medicare payment rates for the Hospital Outpatient Prospective Payment System. In the rule, CMS expressed interest in advancing to digital quality measurement and the use of Fast Healthcare Interoperability Resources (FHIR) in outpatient quality programs. FHIR is a standard that defines how health care information can be exchanged between different computer systems.

“While ACP is generally supportive of FHIR, we raised the point that small and independent practices that are dependent upon third-party vendors are worried about the proposals in this space,” Johnson said. To address such worries, ACP is encouraging CMS to collaborate with stakeholders to better understand the real-world circumstances that these practices could potentially face.

ACP also reiterated its support for the Biden administration requirement that all health care workers be vaccinated against highly transmissible diseases that pose a substantial risk for transmission, including COVID-19, as a condition of employment. Similarly, ACP supports the Occupational Safety and Health Administration requirement that workers at companies with more than 100 employees be vaccinated or tested.

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Back to the December 17, 2021 issue of ACP Advocate