The United Specialists for Patient Access (USPA) – a coalition of practitioners and affiliated entities involved in providing office-based specialty care – is sounding the alarm regarding painful 20% payment cuts to critical services in the proposed Physician Fee Schedule (PFS) Rule for CY2022.

A second-order effect of a CMS proposal to update clinical labor data in the PFS, the 20% cuts are caused primarily from the so-called PFS “budget neutrality” provision — a misnomer that camouflages the impact to frontline office-based providers.

PFS “budget-neutrality” also was a second-order effect from the 2021 CMS “E&M” policy resulting in a massive 10% across-the-board cut to the PFS and has been driving huge reimbursement reductions over the last decade for a number of specialties, including cardiology, physical therapy, radiation oncology, radiology, and vascular surgery, among others. PFS “budget-neutrality,” which is badly in need of reform, is also a catalyst in driving health inequities, health system consolidation, and creating higher Medicare costs, a media release from USPA explains.

“While the Biden Administration is trying to take proactive steps to address structural inequities in our healthcare system, this CMS proposal on the PFS is a stumbling block. Many of the services affected by this CMS cut will impact Black, Latino, and other people of color the hardest. This misguided ‘budget-neutrality’ formula is setting in motion a downward spiral in the quality of care for patients.

“The proposed cut of 20% is also adding fuel to the fire of health system consolidation. The result will be reduced healthcare choice for all patients and even less for minority communities. Many specialists who serve minority populations will be forced to close their doors due to inadequate federal reimbursement and instability. On top of this, the COVID-19 pandemic is not yet behind us and threatens a resurgence. We learned last year how important it was to make sure office-based interventions are viable so hospitals can focus on COVID-19 patients.”

— Dr. Mark Garcia, USPA Board Member and Health Policy Advisor

The USPA strongly urges CMS not to finalize the clinical labor policy in the 2022 PFS Proposed Rule as the second-order negative impacts far outweigh any benefit from updated clinical labor data at this time.

Moreover, considering PFS “budget neutrality” effects from the 2021 PFS Final Rule E/M policy are still causing negative impacts in the form of a scheduled 3.75% cut to the conversion factor in 2022, we urge CMS to work with Congress on fundamental reform to the PFS so that Congress may better address the upcoming 3.75% cut in legislation later this year, the release continues.

[Source(s): United Specialists for Patient Access, PRWeb]

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