Heart of Health Policy

Time For Action: Tell Congress to Protect Patient Access to Medicare Services

Ad Image

On Jan. 1, 2022, physician practices face an array of significant reductions in Medicare payments due to a series of statutory and regulatory cuts. These looming cuts would have devastating impacts on cardiology practices working on the front lines treating Medicare patients, many of whom are at greatest risk for COVID-19.

"Individually, each of the reductions would be painful; taken together, they would be devastating," said ACC President Dipti Itchhaporia, MD, FACC, during ACC's 2021 Legislative Conference. "We must ask members of Congress to act now to stop the cuts and ensure Medicare patients have access to cardiovascular services." Among the anticipated cuts:

  • Expiration of the current reprieve from the 2% Medicare sequester created by the Budget Control Act of 2011, which now is expected to continue into 2031, despite being originally slated for sunset in 2021.
  • Imposition of a 4% Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act of 2021.
  • Expiration of the congressionally enacted 3.75% temporary, public health emergency-linked increase in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustments resulting from Medicare policy changes.
  • Substantial reduction of roughly 25% for electrophysiology ablation services resulting from updated physician work values included in the proposed 2022 Medicare PFS.
  • Practice expense decreases ranging from 5% to 20% for services such as echocardiography, advanced imaging and office-based vein therapies resulting from a necessary adjustment to clinical labor rates included in the proposed 2022 PFS.

The ACC is actively engaged in communicating with Congress to convey how detrimental these cuts will be to patient care and the topic was top-of-mind during hundreds of virtual meetings with congressional leaders and their staff as part of the Legislative Conference this month. ACC members are encouraged to help amplify these messages by contacting their members of Congress and urging support to stop the cuts.

For more information about other health policy issues discussed with lawmakers as part of the 2021 Legislative Conference, visit ACC.org/LegislativeConference.

More COVID-19 Relief Funding On the Way

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has released $25.5 billion in funding for health care providers affected by the COVID-19 pandemic. The funding includes $8.5 billion in American Rescue Plan resources for providers who serve rural Medicaid, Children's Health Insurance Program (CHIP) or Medicare beneficiaries, as well as $17 billion in Provider Relief Fund (PRF) Phase 4 payments for providers who can document revenue loss and expenses related to the pandemic.

PRF Phase 4 payments will reimburse smaller providers, who often serve vulnerable and isolated communities, for lost revenue and COVID-19 expenses at a higher rate compared with larger providers. In addition, PRF Phase 4 payments will include bonus payments for providers who serve Medicaid, CHIP and/or Medicare beneficiaries. Similarly, HRSA will make American Rescue Plan rural payments to providers based on the amount of Medicaid, CHIP and/or Medicare services they provide to patients who live in rural areas. Providers will be able to apply for both programs in a single application, and HRSA will use existing claims data to calculate payments.

Additionally, HHS has delayed the final 60-day grace period for providers who failed to meet the Sept. 30 PRF reporting requirement deadline.

Click here for information about eligibility requirements, application requirements and the application process for PRF Phase 4 payments and American Rescue Plan rural payments.

ACC Comments on CMS 2022 Medicare PFS Proposed Rule

In a formal comment letter to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2022 Medicare Physician Fee Schedule (PFS), the ACC addresses payment policy and technical changes that drive payment for individual services, as well as other programmatic topics related to the Quality Payment Program, Merit-Based Incentive Payment System (MIPS) Value Pathways (MVPs) and others outlined for 2022.

As part of the comments, the ACC urges CMS not to finalize a broad proposal that would require billing of split/shared visits by physicians and advanced practice providers exclusively by time. Additionally, the letter urges the Agency not to finalize a proposal that would increase practice expense costs for clinical staff labor in a manner that precipitously reduces payment for other services. Proposed work relative value unit (RVU) reductions that result from bundling several services involved in electrophysiology ablation are also addressed in detail, with the ACC urging caution, accuracy and a phase-in of any significant reductions that may still occur.

Click here to read about these and other recommendations included in the letter.

CMS is expected to release the final 2022 Medicare PFS, as well as the 2022 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payments rule, in early November.

Click here to read the full PFS comment letter.

Keywords: ACC Publications, Cardiology Magazine

< Back to Listings