2021 Medicare Physician Fee Schedule
On Aug. 3, the Centers for Medicare & Medicaid Services released its proposed physician fee schedule for 2021. This is a proposed rule, and a final rule is not expected until December.
As proposed, the Medicare 2021 Physician Fee Schedule will result in an overall significant, negative 6% impact to ophthalmology. This number doesn’t tell the whole story, with some of our subspecialties like cataract and retina seeing 9% to 10% cuts. The Academy has been working with the American College of Surgeons and other surgical societies,as well as the American Medical Association (AMA), to get Congress to intervene to halt the cuts.
Another problem with the proposed rule is that Centers for Medicare & Medicaid Services (CMS) has only accepted 75% of the AMA’s Relative Value Scale Update Committee (RUC) recommendations. The RUC is a unique multispecialty committee dedicated to making recommendations on physician work and practice resources CMS considers in developing relative value units (RVUs) that determine payment for services.
CMS’ E/M Proposal and 2021 Medicare Payment Cuts
In the proposed 2021 fee schedule rule, CMS announced that it is not making the changes that the Academy and other surgical groups requested to the evaluation and management (E/M) policy changes that CMS intends to implement on January 1, 2021. This means scheduled 2021 E/M increases remain unapplied to post-operative visits in the global surgical payment. CMS repeatedly challenged the accuracy of the number of post-op visits provided under global payments. Although the Academy supports an increase in payment for the E/M codes, a statutory requirement for budget neutrality results in ophthalmology and other surgical specialties experiencing substantial payment cuts. The Academy and other surgical organizations believe that the decision not to the E/M increases to the post-operative visits in the global surgical payment violates federal law which specifically prohibits CMS from paying physicians differently for the same work.
Despite reasonable arguments against it, including by AMA’s Relative-Value Update Committee (RUC), CMS did not depart from an earlier rule that establishes an add-on “complexity” code for some E/M office visits starting Jan. 1, 2021. This add-on code was not recommended by the RUC and violates Resource Based Relative Value Scales (RBRVS). It significantly increases the negative impact on surgeons and specialists. In addition, CMS noted it is considering refining its utilization assumptions for the code, which could lead to utilization restrictions that would preclude use by ophthalmology.
The Academy has intensified its efforts to compel congressional action to ensure an outcome that is fair to ophthalmologists. The Academy is a founding member of the new Surgical Care Coalition (www.surgicalcare.org), which includes the American College of Surgeons and 10 other surgical specialties. Our coalition is calling on Congress to take action before the end of the year to prevent the payment cuts and to require CMS to apply the E/M payment increases to the post-op visits in the global codes.
The Academy and its Surgical Care Coalition partners worked with Reps. Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind., to craft a legislative solution, HR 8702, that will provide stability for surgeons, their practices, and their patients. In October, Bera and Bucshon introduced the “Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020.” For those providers that would experience a payment cut in 2021, this bipartisan bill would ensure payments to these providers are kept stable at 2020 levels for the next two years.