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Final 2021 Medicare Physician Fee Schedule Released

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ACP continues its work to protect the beneficial changes in the 2021 fee schedule, urges Congress to waive budget neutrality

Dec. 18, 2020 (ACP) – The 2021 Medicare Physician Fee Schedule Final Rule has been released and will go into effect on Jan. 1. But it may still change – for better, worse or both. The American College of Physicians is enlisting its grassroots advocates to urge Congress to make decisions that protect the interests of patients and physicians.

“We still have a lot of work to do to protect our gains in the fee schedule and improve upon them,” said Shari Erickson, ACP vice president for governmental affairs and medical practice.

ACP is asking Congress to waive the requirement for “budget neutrality” – in which new costs are balanced by new cuts – in 2021. However, it is critical that this is done without eliminating any of the beneficial 2021 changes that have been finalized by the agency. These changes include increased payments for outpatient evaluation and management (E/M) services and implementation of the G2211 (formerly referred to as GPC1X) billing code, which would provide increased payment for complex care.

“Congress is very aware of [the budget neutrality] issue and is considering ways to intervene. This is not an ideal time for cuts that affect physicians, particularly in the midst of a pandemic,” Erickson said. “The challenge is that some on Capitol Hill are advocating to delay or phase in the E/M increase. We outright oppose such a move, and our members are reaching out to their representatives to make their feelings known.”

There's an urgent need for action, she said, because the fee schedule goes into effect so soon. As ACP told congressional leaders in a Dec. 2 letter, the positive changes in the fee schedule “begin to address the decades-long disparities in payments for E/M services, and the underinvestment in primary and comprehensive care, and deserve your enthusiastic support as finalized by [the Centers for Medicare & Medicaid Services (CMS)] for implementation on January 1, 2021.”

ACP is also pushing for improvements to the fee schedule. “I fear we may see a multitude of offices being forced to shut their doors over the next year, leaving their patient populations without care. There are additional measures that CMS can and should take to help mitigate this issue and preserve patients' access to care,” said Dr. Jacqueline W. Fincher, president of ACP.

Specifically, ACP is calling attention to the following inadequacies in the 2021 fee schedule:

  • While CMS extended payment for audio-only services beyond the end of the pandemic, it will be via a new code that will lower the payments for these services.
  • CMS declined to move forward with an evaluation of the codes used for payment for vaccines, leaving those reimbursements stagnant at 2019 levels. ACP has warned that the lower payment will not cover the expected increase in costs associated with vaccine purchase, storage, administration and recordkeeping during a time when practices will need to facilitate unprecedented vaccine administration coordination for the COVID-19 vaccine.

ACP has also been monitoring the finalizing of the Quality Payment Program (QPP) rule for 2021 and is pleased that CMS will extend the extreme and uncontrollable circumstances hardship exception policy to 2021 as a response to the COVID-19 pandemic. “This is a huge win for us,” Erickson said.

This extension will benefit physician practices under the Merit-based Incentive Payment System (MIPS) by giving them extra flexibility. “If they have any challenges whatsoever with being able to participate in the MIPS program, they will be able to file for an exemption,” she said.

However, ACP is disappointed by the government's failure to provide other adjustments to the QPP in 2021. “They are not implementing – or are reversing – a lot of flexibility for MIPS and Alternative Payment Models (APMs),” Erickson said. “Our members will be very challenged to participate in these programs in 2021.”

For example, the final QPP rule reverses a proposal to lower the MIPS performance threshold and reverses a proposal to use 2021 data to score quality measures and will instead rely on prepandemic benchmarks. It also increases the weight of the cost category without addressing longstanding concerns. And the Advanced APMs pathway fails to include any broad pandemic-related protections for thousands of participating physicians.

ACP will continue its advocacy and push CMS to act. “Physician practices are under horrendous financial and emotional stress this year. Our health care system is ailing, and fault lines have formed. I am deeply concerned about all of our patients and their access to care,” Fincher said. “We need CMS to do as much as possible to support physicians in providing the best possible care to patients in this time of crisis.”

More Information

ACP is urging members to reach out to lawmakers through the “ACP Action Alert: Tell Congress Not to Delay CMS's Final 2021 Medicare Payment Increases for Outpatient Visits!” available on the ACP website.

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Back to the December 18, 2020 issue of ACP Advocate