THE GOOD, BAD AND THE UGLY
Telehealth services are preserved through 2023 and evaluation management services are expanded.
Expiration of the congressionally enacted 3.75% temporary increase in Medicare physician fee schedule conversion factor, reducing the conversion factor by 3.75%.
Addition of 6% cuts, 2% from 2011 of Obama era, and 4% from American Rescue Plan Act of 2021, totaling 6%.
It could get even uglier if Congress passes infrastructure bills as one unit or 2 units, which may add additional 4% or more to the cuts.
On July 13, 2021, CMS issued a proposed rule updating payment policies and rates for physicians paid under the Medicare Physician fee schedule in 2022. The proposed rule illustrates includes a 9.75% cut in the reimbursement rates from 2021. This affects interventional pain physicians, along with the entire physician and provider community.
The proposed rule is available at: https://www.govinfo.gov/content/pkg/FR-2021-07-23/pdf/2021-14973.pdf
The proposed rule illustrates the importance of ASIPP’s regulatory advocacy efforts on behalf of interventional pain physicians – the only organization focused on reducing or eliminating these cuts.
While we continue to face the financial uncertainty with COVID-19 pandemic, our practices continue to be stretched to their limits clinically, emotionally, and financially as the pandemic persists with 15% to 25% reductions in our services compared to 2019 and at least 10% to 15% in overall increase in practice expenses. On January 1, 2022, physician practices face the significant cuts creating a perfect storm:
- Expiration of the congressionally-enacted 3.75% temporary increase in the Medicare physician fee schedule conversion factor to avoid payment cuts associated with budget neutrality adjustment tied to physician fee schedule policy changes.
- Expiration of the current reprieve from the repeatedly extended 2% sequester stemming from Budget Control Act of 2011 (unfortunately, Congress originally scheduled this policy to sunset in 2021, but it will now continue into 2030).
- Imposition of a 4% statutory PAYGO sequester resulting from passage of American’s Rescue Plan Act, lasting at least 10 years (if Congress fails to act, it appears that this will mark the first time that Congress has failed to waive statutory PAYGO).
- In addition to the above 9.75% cuts, there are also other cuts looming.
A statutory freeze in the annual Medicare fee-for-service (FFS) updates under the Medicare Access and CHIP Reauthorization Act (MACRA) that is scheduled to last until 2026, when updates resume at a rate of 0.25% a year indefinitely. However, this is well below the rate of medical or consumer price index inflation. Physician payments have been the lowest compared to consumer price index or payment index and even much lower than hospital outpatient department (HOPD) payments and skilled nursing facility payments.
Further, potential penalties under the Merit-based Incentive Payment System (MIPS) will increase to 9% in 2022. The merit-based system continues to stress practices with unnecessary measurements and increase in costs.
Overall, as per AMA, adjusted for inflation in practice costs, Medicare physician payment actually declined 22% from 2001 to 2020 or by 1.3% per year on average.
This effect will significantly affect patient care and access.
EVALUATION AND MANAGEMENT (E/M) VISITS
CMS continues its ongoing review of E/M code sets. ASIPP is supportive of new coding and payment structure implemented on January 1, 2021. While multiple other proposals are being made in revising these code guidelines, as of now, it appears that audio-only visits will continue to be reimbursed philosophically on the same approach as 2021. The bottom line appears to be that CMS will retain all telehealth services added due to the public health emergency through calender year 2023 so that they can be analyzed and submitted for the 2023 and 2024 fee schedules for permanent inclusion. There are also multiple bills in the Congress supporting this philosophy.
Overall, this is a welcome decision by CMS as it gives providers a clear timeframe during which they can continue to utilize these temporarily approved telehealth services and allows for assessment for permanent inclusion.
THE EFFECT OF CONVERSION FACTOR AND ESTIMATED PAYMENT SCHEDULE FOR INTERVENTIONAL PAIN PHYSICIANS
As shown in Table 1, there are multiple changes anticipated in the fee schedule. Click here to view.
- Without change in the conversion factor, we would probably see a small increase.
- With change in the conversion factor, the changes are ranging from 1.7% to 24% for non-facility fee schedule, whereas facility fee schedule shows changes not exceeding 3% to 4% for commonly performed procedures. The major reductions in fee schedule for non-facility setting procedures are related to vertebral augmentation procedures from 16.1% to 25%.
Greater than 10% reductions are also seen for hip injections, percutaneous adhesiolysis, discography procedures, fluoroscopically guided epidural injections, and implant of neuroelectrodes.
- For services performed at facilities, the reductions are modest reflecting the 3.7% cut in the conversion factor.
However, when we add 6% cut to the payment after 3.5%, it will be devastating with some cuts exceeding 30%.
CALL FOR ACTION
At this time, ASIPP is vigorously working with Congress to reverse the cut in the conversion factor and also sequester cuts and PAYGO cuts. We would like also to prevent any further PAYGO risks with passage of 2 new bills in the Congress. If these 2 new bills pass separately, there is a risk of 8% additional cuts. However, if they pass as one, there will be a maximum of 4% cuts. Consequently, it is essential to stop all of these, or eliminate PAYGO option for the cuts.
ASIPP is a not-for-profit professional organization founded in 1998 now comprising over 4,500 interventional pain physicians and other practitioners who are dedicated to ensuring safe, appropriate and equal access to essential pain management services for patients across the country suffering with chronic and acute pain. There are approximately 8,500 appropriately trained and qualified physicians practicing interventional pain management in the United States. ASIPP is comprised of 49 state societies of Interventional Pain Physicians, including Puerto Rico and the affiliated Texas Pain Society.
The comment period ends September 13, 2021.
If you have any comments that you would like added, or if you would like to write your own comments, please feel free to do so. You may contact: Laxmaiah Manchikanti, MD, Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS at 270-554-8373 ext. 4101 or email at [email protected] and/or Amol Soin, MD, President, ASIPP and SIPMS, at 937-434-2226 or email at [email protected]