Physician groups mount effort to get Congress to avert nearly 4% Medicare payment cut from taking effect in 2022

Several physician groups are mounting a new effort to persuade Congress to step in and prevent a nearly 4% cut to Medicare payments to physicians from going into effect in 2022.

The 2022 Physician Fee Schedule, released late Tuesday by the Centers for Medicare & Medicaid Services, proposes to cut the Medicare conversion factor, used to calculate Medicare reimbursements, by 3.75% in 2022. Congress had averted the 3.75% cut from going into effect for 2021, but that moratorium ends after this year.

“By acting to mitigate reimbursement cuts for surgical care, Congress acknowledged how misguided and devastating CMS's policies are to patients,” said Alan Speir, a member of the Society of Thoracic Surgeons Council, in a statement. “Congress must intervene again to ensure that patients are able to access the lifesaving care they need.”

Medicare pays physicians based on a conversion factor. The 2022 Physician Fee Schedule proposed a conversion factor of $33.58, a $1.31 decline from 2021’s total.

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The Surgical Care Coalition, an advocacy group of 13 surgical associations, said in a release that updates to the conversion factor have not kept up with inflation.

“The result is that the conversion factor is only about 50% of what it would have been if it had been indexed to general inflation as it had been prior to 1998,” the coalition said in a release Tuesday.

The Physician Fee Schedule payments must be budget neutral, meaning any pay raises for one specialty must come with cuts to another.

Congress included an extra $3 billion for the Physician Fee Schedule in a late 2020 spending package to fund the 3.75% increase to the conversion factor, but the funding runs out at the end of this year.

If the 3.75% cut goes into effect in 2022 then it will affect all specialties, said Christian Shalgian, director of advocacy and health policy for the American College of Surgeons, in an interview with Fierce Healthcare. The association is one of the members of the Surgical Care Coalition.

Other physician groups have called on Congress to step in again. The Medical Group Management Association said in a statement Tuesday that it will also seek “congressional intervention to avert the cut.”

The American Medical Group Association also warned that the cuts could be a major hit for physician finances especially as payment cuts made under the sequester could resume. Congress had paused the sequester cuts last year to help providers struggling financially due to COVID-19, but the moratorium on the cuts also expires at the end of 2021.

Shalgian said physician groups have urged Congress to consider not just a temporary fix.

“We need to have these conversations about a permanent solution, so we aren’t doing this every year,” he said. “Private payers tie their rates to Medicare so that there is always that instability out there on what the practice is going to look like from a financial perspective.”

Shalgian added that other sectors in healthcare get inflationary adjustments in their payment changes, but “we are just trying to fight back to a freeze. We are not even getting an inflationary adjustment.”