Health equity could get worse unless Congress acts

Last month, the Centers for Medicare & Medicaid Services (CMS) issued a final decision to move forward with the clinical labor policy that includes changes for Medicare payments under the Physician Fee Schedule (PFS). The changes will be effective Jan. 1, 2022 and will ultimately force cuts onto providers, limit patient access and destabilize the health care system by squeezing out service providers who typically provide comprehensive care to a predominantly vulnerable population.

Needless to say, these cuts, the result of a flawed PFS methodology, paint a bleak picture for patients should they go forward.

The CMS rule change means a 20 percent across-the-board cut to specialty providers. As currently prescribed, the Physician Fee Schedule (PFS) contains cuts that will significantly and adversely affect a broad range of office-based specialists; for example, cardiology, interventional nephrology, interventional radiology, physical therapy, phlebology, radiation oncology, radiology, vascular surgery, and many more services that free-standing medical facility patients depend on.

The driver behind these cuts is the “budget-neutrality” requirement — a misnomer of the highest order — which dictates that first order updates to PFS data cause indiscriminate factor decreases elsewhere and, consequently, drastic reductions in payments. Over the years, as the total allocation of funding for PFS services has been dropping in real dollars due to inflation, policies to reallocate funds from specialists to primary care are doing lasting damage to specialists and causing office-based centers to close. As a result, patients are being forced to find care in the hospital, which actually costs the system more! These concerns stem from CMS implementing the clinical labor policy. For 2022, budget-neutrality effects of the new clinical labor data results in massive cuts of more than 15 to 20 percent to critical services in the PFS.  And, make no mistake about it, with these cuts, it is the patients who are

feeling the pain.

There is a way to fix this. Members of Congress can stop these cuts in the February omnibus appropriations legislation and provide relief to office-based specialists.

Many stakeholders are concerned that if these cuts go forward, they will continue to exacerbate the deterioration of quality health care delivery to the patient. It also will result in increased Medicare spending and likely lead to higher Medicare premiums and deductibles.These cuts also disproportionately impact people of color, as many of the services affected by these cuts will strike the Black, Latino, and other minority communities the hardest.

But, accessible, affordable, and comprehensive health care for Americans should not be a zero-sum proposition. Both physicians and patients deserve more than that. With these cuts, the impact is both obvious and devastating — a principal reason that leaders of the Congressional Tri-Caucus, comprised of the Congressional Asian Pacific American Caucus (CAPAC), Congressional Black Caucus (CBC), and Congressional Hispanic Caucus (CHC), are calling for a reversal of these cuts.

Even CMS acknowledges that there are obvious ‘negative effects’ of their decision. The harsh reality is that small health care providers and office-based providers can’t stay in business with inadequate reimbursement rates from the federal government. The time for action is now: we must urge our leaders to overturn these cuts and put the care of patients first.

Dr. Mark Garcia, CMO for American Vascular Associates and the Health Policy Advisor for United Specialists for Patient Access (USPA).