Rheumatologists, many of whom have struggled to keep their doors open and continue caring for patients through the COVID-19 pandemic, are facing a new and significant challenge—a 9.75% overall cut to Medicare reimbursement rates. The cuts arise from a combination of federal policies, including the latest Medicare Physician Fee Schedule (MPFS), scheduled to take effect simultaneously Jan. 1, 2022, according to Elizabeth (Blair) Solow, MD, chair of the ACR’s Government Affairs Committee and a rheumatologist with the UT Southwestern Medical Center in Dallas.
“Cognitive specialists, such as rheumatologists, rely on adequate reimbursement for their work, including critical thinking and management of long-term diseases. Any cuts to reimbursement, particularly of this magnitude, will strain providers’ ability to keep their practice above water,” Dr. Solow cautions.
Congress has recognized in the recent past how such cuts will be detrimental to providers and has implemented temporary legislative fixes, she explains. “We hope Congress will consider similar legislative interventions again to help providers continue taking care of patients with rheumatic diseases.”
ACR President David Karp, MD, PhD, stresses how important it is for rheumatologists to speak up about the negative effects these cuts will have on patient care and to work with other groups that represent providers whose major billings come from the Centers for Medicare & Medicaid Services (CMS) and on Capitol Hill. “Unfortunately, once cuts are enacted, they are difficult to reverse, so it is imperative that the ACR and its members act now to prevent this from happening,” he says.
How the Final Cuts Equal 9.75%
Three simultaneous cuts will combine to reduce provider payments through Medicare by 9.75%, explains Lennie McDaniel, JD, ACR director of congressional affairs.
The first is a 2% Medicare sequestration cut that has been made annually since 2013 through the Budget Control Act of 2011. In the past, however, Congress has placed a moratorium on this cut, including the most recent extension of the moratorium through the 2020 CARES Act.
The second cut comes from the expiration of a COVID-19 relief measure that bumped provider reimbursements up by 3.75%. This adjustment to the conversion factor for all Medicare services in 2021 was implemented to afford some short-term stability for healthcare professionals struggling with the financial impact of the COVID-19 pandemic. The relief measure expires Dec. 31, 2021, “even though the pandemic continues to wreak havoc on providers across the country,” Ms. McDaniel notes.