Congress: To improve health equity, provide relief for office-based specialty care

Just hours after being inaugurated, President Biden signed an executive order commanding the federal government to make racial equity a top priority. Given the stark disparities that continue to plague communities of color—especially when it comes to America’s health care system—this was a welcome first step by the administration.

While the administration’s commitment to health equity is encouraging, regulations from the Centers for Medicare & Medicaid Services (CMS) that were implemented on Jan. 1 seem to contradict this promise just a year after it was made. Despite underserved communities still facing access barriers to health care providers, Medicare slashed funding for specialty care services by upwards of 20 percent. If left in place, these severe cuts will lead to significantly worse health outcomes for Black, Hispanic, and Native Americans—including an increase easily preventable limb amputation.

Medicare “clinical labor” cuts to many specialty services including cardiology, radiation oncology, and radiology services offered in the outpatient setting will impact underserved populations in the communities where they live the most. One of the hardest hit specialty services is revascularization, a procedure used for vascular care and limb preservation; it was cut by a staggering 22 percent.

Minimally invasive revascularization is important because it helps restore a patient’s blood flow after his or her arteries become clogged with plaque, an all-too-common complication of diabetes, chronic kidney disease, and obesity called peripheral artery disease (PAD). If left untreated, PAD can eventually lead to permanent damage that necessitates an amputation. While amputation can easily be prevented with access to early detection and intervention, too few Americans even see a revascularization specialist until it’s too late. As a result, roughly 200,000 people in the United States undergo non-traumatic amputations every year—as much as 85 percent of which could be prevented with timely care.

Unfortunately, communities of color experience PAD at greater rates than other patient groups. In a 2021 letter to CMS, 75 lawmakers in the House of Representatives—led by Reps. Bobby Rush (D-Ill.) and Gus Bilirakis (R-Fla.)— highlighted the disparate impacts that the cuts would have on communities of color. Specifically, Black and Latino Medicare beneficiaries who are three times more likely and twice as likely, respectively, to receive an amputation due to peripheral artery disease.

It doesn’t have to be this way. With access to quality care close to home, we can close the gap. But slashing Medicare payments by 22 percent will instead put pressure on outpatient offices to close, further reducing patient access and increasing the risk of patients developing dangerous complications.

Congress must intervene as soon as possible.

While Congress passed legislation in December to provide temporary relief from a majority of the Medicare conversion factor cuts scheduled to take place on January 1, these “clinical labor” cuts of more than 20 percent for office-based specialists were left unaddressed. These cuts are the most significant payment cuts under the 2022 Physician Fee Schedule and threaten to undermine efforts to address health inequity, reduce health system consolidation, and manage the challenges of providing care during the pandemic.

I urge Congress to address these cuts in the omnibus appropriations legislation expected in February. If Congress fails to act, these cuts threaten to cause severe clinical, economic, and human impacts on a vulnerable population that already suffers in isolation. With patient access to care and critical progress for health equity across America at stake, I hope our leaders will do the right thing and eliminate these cuts. 

Foluso Fakorede, MD, is CEO of Cardiovascular Solutions of Central Mississippi.