AMA welcomes burden relief for office visit services finalized in the Medicare Payment Rule, but urges Congress to prevent or postpone shocking Medicare offsets
On December 1, the Centers for Medicare & Medicaid Services (CMS) released the 2021 Medicare Physician Payment Schedule Final Rule. AMA staff is analyzing the rule and will release a detailed summary shortly.
“Foundational improvements are coming on January 1 to the coding, documentation, and payment of evaluation and management (E/M) services for office visits as the newly announced Medicare payment rule finalized revised guidelines and payment rates,” said AMA President Susan R. Bailey, MD.
The January 2021 office visit guidelines and descriptions; an AMA Ed Hub tutorial; detailed RUC recommendations, data, and a vote report are all posted on the AMA website and may be obtained via www.ama-assn.org/cpt-office-visits.
These Medicare changes match the physician-led recommendations of an AMA assembled joint work group. The process for coding and documenting E/M office visit services is now simpler and more flexible, allowing physicians to select the appropriate code based on medical decision-making or total time
“Unfortunately, the newly adopted office visit payment rates, and other payment increases finalized in the rule, are required by statute to be offset by payment reductions to other medical services covered by Medicare. This will result in a shocking reduction of 10.2% to Medicare payment rates in the midst of the worsening COVID-19 pandemic while physicians are continuing to care for record numbers of patients diagnosed with COVID-19 and trying to keep the lights on in their practices. These cuts will hurt all Medicare patients, particularly those seeking care for COVID-19 critical care and hospital visits that will be reduced dramatically,” Dr. Bailey added.
“For this reason, the AMA strongly urges Congress to prevent or postpone the payment reductions resulting from Medicare’s budget neutrality requirement. Physicians are already experiencing substantial economic hardships due to COVID-19, so these payment cuts could not come at a worse time.”
Budget Neutrality Adjustments
By law, significant increases in Medicare physician payment rates must be offset by across-the-board decreases. This budget neutrality requirement means that the RUC recommendations for the office and outpatient E/M visits would lead to an approximate 5% payment reduction affecting physicians and other health professionals who do not report office visits. This reduction was doubled to more than 10% as a result of other policy changes made by CMS. In particular, despite concerns about a lack of clarity in its definition and estimated utilization, CMS finalized a new code, G2211, to be reported in addition to the CPT codes for office visits which requires an additional budget neutrality offset of about $3 billion.
Despite the consensus of the AMA and the Federation that CMS should waive the budget neutrality impacts of the Medicare E/M policies in light of the COVID-19 public health emergency, CMS has finalized a significant budget neutrality adjustment. The CY 2021 physician payment conversion factor is $32.41, a decrease of $3.68 from the CY 2020 conversion factor of $36.09. This is a decrease of 10.2%. The CY 2021 anesthesia conversion factor is $20.04, a decrease of $2.15 from the CY 2020 conversion factor of $22.20.
The table below illustrates the specialty payment impacts. Redistributions will be significant, with family medicine increasing by 13% and many specialties that do not perform office visits decreasing by 8% or more.
Because the Administration does not offer any relief from the budget neutrality cuts in the final rule, the AMA strongly urges Congress to avert the more than 10% cut as physicians are experiencing substantial economic hardships due to the COVID-19 public health emergency. Cuts of this magnitude are problematic for all services, but we are extremely concerned that these cuts will directly impact care to COVID-19 patients, as payments for hospital visits, critical care visits, nursing home visits, and home visits are among those being slashed.
|
(A) Specialty |
(B) Allowed Charges (mil) |
(C) Impact of Work RVU Changes |
(D) Impact of PE RVU Changes |
(E) Impact of MP RVU Changes |
(F) Combined Impact |
|
ALLERGY/IMMUNOLOGY |
$247 |
5% |
4% |
0% |
9% |
|
ANESTHESIOLOGY |
$2,020 |
-6% |
-1% |
0% |
-8% |
|
AUDIOLOGIST |
$75 |
-4% |
-2% |
0% |
-6% |
|
CARDIAC SURGERY |
$266 |
-5% |
-2% |
0% |
-8% |
|
CARDIOLOGY |
$6,871 |
1% |
0% |
0% |
1% |
|
CHIROPRACTOR |
$765 |
-7% |
-3% |
0% |
-10% |
|
CLINICAL PSYCHOLOGIST |
$832 |
0% |
0% |
0% |
0% |
|
CLINICAL SOCIAL WORKER |
$857 |
0% |
1% |
0% |
1% |
|
COLON AND RECTAL SURGERY |
$168 |
-4% |
-1% |
0% |
-5% |
|
CRITICAL CARE |
$378 |
-6% |
-1% |
0% |
-7% |
|
DERMATOLOGY |
$3,767 |
-1% |
0% |
0% |
-1% |
|
DIAGNOSTIC TESTING FACILITY |
$748 |
-1% |
-2% |
0% |
-3% |
|
EMERGENCY MEDICINE |
$3,077 |
-5% |
-1% |
0% |
-6% |
|
ENDOCRINOLOGY |
$508 |
10% |
5% |
1% |
16% |
|
FAMILY PRACTICE |
$6,020 |
8% |
4% |
0% |
13% |
|
GASTROENTEROLOGY |
$1,757 |
-3% |
-1% |
0% |
-4% |
|
GENERAL PRACTICE |
$412 |
5% |
2% |
0% |
7% |
|
GENERAL SURGERY |
$2,057 |
-4% |
-2% |
0% |
-6% |
|
GERIATRICS |
$192 |
1% |
1% |
0% |
3% |
|
HAND SURGERY |
$246 |
-2% |
-1% |
0% |
-3% |
|
HEMATOLOGY/ONCOLOGY |
$1,707 |
8% |
5% |
1% |
14% |
|
INDEPENDENT LABORATORY |
$645 |
-3% |
-2% |
0% |
-5% |
|
INFECTIOUS DISEASE |
$656 |
-4% |
-1% |
0% |
-4% |
|
INTERNAL MEDICINE |
$10,730 |
2% |
1% |
0% |
4% |
|
INTERVENTIONAL PAIN MGMT |
$936 |
3% |
3% |
0% |
7% |
|
INTERVENTIONAL RADIOLOGY |
$499 |
-3% |
-5% |
0% |
-8% |
|
MULTISPECIALTY CLINIC/OTHER PHYS |
$153 |
-3% |
-1% |
0% |
-3% |
|
NEPHROLOGY |
$2,225 |
4% |
2% |
0% |
6% |
|
NEUROLOGY |
$1,522 |
3% |
2% |
0% |
6% |
|
NEUROSURGERY |
$811 |
-4% |
-2% |
-1% |
-6% |
|
NUCLEAR MEDICINE |
$56 |
-5% |
-3% |
0% |
-8% |
|
NURSE ANES / ANES ASST |
$1,321 |
-9% |
-1% |
0% |
-10% |
|
NURSE PRACTITIONER |
$5,100 |
5% |
3% |
0% |
7% |
|
OBSTETRICS/GYNECOLOGY |
$636 |
4% |
3% |
0% |
7% |
|
OPHTHALMOLOGY |
$5,343 |
-4% |
-2% |
0% |
-6% |
|
OPTOMETRY |
$1,359 |
-2% |
-2% |
0% |
-4% |
|
ORAL/MAXILLOFACIAL SURGERY |
$79 |
-2% |
-2% |
0% |
-4% |
|
ORTHOPEDIC SURGERY |
$3,812 |
-3% |
-1% |
0% |
-4% |
|
OTHER |
$48 |
-3% |
-2% |
0% |
-5% |
|
OTOLARNGOLOGY |
$1,271 |
4% |
3% |
0% |
7% |
|
PATHOLOGY |
$1,265 |
-5% |
-4% |
0% |
-9% |
|
PEDIATRICS |
$67 |
4% |
2% |
0% |
6% |
|
PHYSICAL MEDICINE |
$1,164 |
-3% |
0% |
0% |
-3% |
|
PHYSICAL/OCCUPATIONAL THERAPY |
$4,973 |
-4% |
-4% |
0% |
-9% |
|
PHYSICIAN ASSISTANT |
$2,901 |
5% |
2% |
0% |
8% |
|
PLASTIC SURGERY |
$382 |
-4% |
-3% |
0% |
-7% |
|
PODIATRY |
$2,133 |
-1% |
0% |
0% |
-1% |
|
PORTABLE X-RAY SUPPLIER |
$95 |
-2% |
-4% |
0% |
-6% |
|
PSYCHIATRY |
$1,112 |
4% |
3% |
0% |
7% |
|
PULMONARY DISEASE |
$1,654 |
0% |
0% |
0% |
1% |
|
RADIATION ONCOLOGY AND RADIATION THERAPY CENTERS |
$1,809 |
-3% |
-3% |
0% |
-5% |
|
RADIOLOGY |
$5,275 |
-6% |
-4% |
0% |
-10% |
|
RHEUMATOLOGY |
$548 |
10% |
5% |
1% |
15% |
|
THORACIC SURGERY |
$352 |
-5% |
-2% |
0% |
-8% |
|
UROLOGY |
$1,810 |
4% |
4% |
0% |
8% |
|
VASCULAR SURGERY |
$1,293 |
-2% |
-4% |
0% |
-6% |
|
TOTAL |
$97,008 |
0% |
0% |
0% |
0% |
* Column F may not equal the sum of columns C, D, and E due to rounding.