The proposed 2021 Medicare Physician Fee Schedule (PFS) includes a roughly 11% decrease in the conversion factor from $36.09 in 2020 to $32.26. Due to a statute under the Medicare Access and CHIP Reauthorization Act (MACRA), the baseline physician payment update for 2021 is 0%. The steep budget neutrality adjustment is required in 2021 to offset the RVU changes to office visit E/M codes, along with other policy changes and Centers for Medicare and Medicaid Services (CMS) proposals, such as use of a new add-on code for ongoing management of a patient's single, serious or complex chronic condition.

Despite this conversion factor cut, CMS estimates that the 2021 PFS will still increase payments to cardiologists by 1% from 2020 to 2021 through updates to work, practice expense and malpractice RVUs. This is because cardiologists provide a significant amount of now higher-paid E/M, so they may avoid dramatic swings seen by others, though payments to individual clinicians or practices will vary depending on the mix of services provided.

Your ACC previously expressed support for changes to E/M structure and payment rates but, like many others, has recently expressed concern that requiring budget neutrality would be disruptive, particularly during the COVID-19 pandemic, and should be waived. ACC Advocacy will continue pressing this and other possible solutions to mitigate disruption of this cut to the conversion factor as part of the PFS public comment period.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub

Keywords: Centers for Medicare and Medicaid Services, U.S., Medicare, COVID-19, Medicaid, severe acute respiratory syndrome coronavirus 2, Fee Schedules, Pandemics, Physicians, Office Visits, Malpractice, ACC Advocacy

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