Academy Joins Large Coalition in Call for CMS to Avert 2021 Payment Cuts

The Academy is continuing its fight for stability in your 2021 Medicare reimbursement, joining a broad coalition seeking a waiver from a budget requirement that would trigger cuts.

Last week, we joined more than 100 other societies in urging U.S. Department of Health and Human Services Secretary Alex Azar to take action. Under changes finalized for the 2021 Medicare fee schedule, the Centers for Medicare & Medicaid Services will substantially increase payments for office visits. In our letter to Azar, the coalition reiterated its support for the improved reimbursements for office visits.

However, CMS must comply with a statutory mandate to offset any increases in one part of the Medicare physician fee schedule by making cuts elsewhere. Under this budget neutrality requirement, the reimbursement changes scheduled to take effect Jan. 1 would result in payment cuts for other services. The Academy expects ophthalmologists would see about a 7% overall cut.

Normally, Congress would have to waive the requirement. But the Public Health Services Act gives the HHS secretary broad authority to respond to public health emergencies like COVID 19. This is why the groups urged Azar to use his agency’s authority to waive the budget neutrality requirements for the new Medicare office visit payment policy.

Doing so would preserve patient access to care and mitigate financial distress due to the pandemic. We pointed out the need to protect payment stability as physician practices continue to recover from the COVID-19 pandemic, especially as some states have once again suspended elective surgeries.

The letter to Azar, spearheaded by the American Medical Association, is the latest tactic in a multipronged Academy strategy to protect your payments. We’ve also joined two other coalitions in pressing Congress to pass legislation to waive the budget-neutrality requirement. We will continue to keep you informed of our ongoing efforts.