September 28, 2021, 1:35 p.m. — No one expects a monolithic annual rule governing physician pay to deliver sunshine and chuckles. But the Medicare physician fee schedule shouldn’t be a nail-biter every year, either.
Here we are, though, wondering why CMS’ 2022 MPFS and Quality Payment Program proposed rule reads like a Stephen King novel when it comes to the conversion factor. One that has a very unhappy ending: potential pay cuts for primary care.
The reasons for this are as convoluted as one of King’s lesser efforts, but I’ll sum them up this way.
You see what I mean: Way too much suspense when what’s needed is stability.
We know that CMS can’t unilaterally set the conversion factor, lacking as it does the power to waive budget neutrality. But CMS has plenty of power to support primary care in other ways, and the AAFP sees several opportunities in the proposed MPFS to do just that. It is, for example, well within the agency’s authority to direct fair valuation for several foundational primary care services.
We also acknowledged there that primary care doesn't come away empty-handed from the rule as written. Several elements proposed in the fee schedule, as detailed in this AAFP News story, show that CMS has been listening to the Academy. In particular, the rule would initiate a long-overdue update of clinical labor pricing, something the agency hasn’t undertaken in almost two decades. All those years spent relying on outdated wage data have contributed to longstanding payment distortions between primary and select specialty care — which is why we are calling on CMS to enact this change immediately.
At the same time, we’re lobbying Congress to maintain that 3.75% increase to the conversion factor through at least 2023, reflecting what we expect to be a protracted recovery from the public health emergency. In July, the Academy joined dozens of other medical and health care groups in explaining to House and Senate leaders why this bridge over the fee schedule’s compromised structure was of paramount importance: to avoid “significant disruptions” to the care Medicare beneficiaries depend upon.
Beyond averting near-term failures, we added, Congress must work with CMS to reform these weaknesses, which have been costly for physicians. “The startling reality is that, adjusted for inflation in practice costs, Medicare physician pay actually declined 22% from 2001 to 2020,” we said.
As the coalition behind that July letter demonstrates, the Academy has been far from an outlier among medical specialty societies in demanding this of Congress. The budget-neutrality requirement at the heart of this latest conversion-factor crisis has for too long stymied U.S. health care by trapping physician payment in outdated formulae. And that was before COVID-19 began termiting its way through the house of medicine, revealing a generation’s worth of decay in the fee-for-service model.
Our comments to CMS touched on plenty of other important topics. We called on regulators there to
The Academy also sounded the alarm on a significant disappointment. Just when primary care practices were set to benefit from that long-overdue payment increase, the AAFP has instead heard from many employed physicians — the population that makes up the bulk of the specialty — that their employers were keeping their contracts at 2020 levels.
“The AAFP urges CMS to use the tools at its disposal, including rulemaking and sub-regulatory guidance, to help ensure the 2021 evaluation and management RVU increases are passed down to primary care physicians,” we wrote. “We understand physicians’ contracts with private payers and the organizations that employ physicians are outside of CMS’ purview. However, we believe it’s important for CMS to know what is happening in this regard as it considers additional efforts to support primary care.”
The Academy will keep pushing CMS and Congress to make every effort possible to support primary care. As I wrote in this space last year, “Accessible, affordable, comprehensive medical care for Americans is not a zero-sum proposition.” The agency can and must deliver stability to family physicians and their patients, who together have been buffeted for almost two years by the COVID-19 pandemic.
Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.