• In The Trenches

    A First Look at November’s Big Rules

    November 9, 2021, 9:38 a.m. — November started with the feeling that every regulation we’d been expecting was going to tumble forth at the same moment. It wasn’t quite that hectic, but it’s been a very busy few days for the Academy’s government relations staff, and the pace isn’t about to let up. So I’ll be brief as I update you on the big stuff, starting with one of those regulations.

    medicare tablet with medical equipment

    CMS issued the 2022 Medicare physician fee schedule and Quality Payment Program final rule last week, and the good news is that it included no big surprises on its way to affording some needed improvements to Academy members. We’re still analyzing the fine print, but I encourage you to read our new executive summary.  

    As we anticipated, the 2022 fee schedule’s conversion factor is 33.59, $1.30 less than 2021’s conversion factor. Last December, to offset the effects of the public health emergency, Congress acted to boost the conversion factor by 3.75%. That increase will expire without new legislation. We’re pushing to make sure we get that and to help bring about a real solution for our old enemy, budget neutrality.  

    Now, a big deal: For the first time since 2002, CMS next year starts updating the “clinical labor” portion of practice expense relative value units to reflect up-to-date wage data and other clinical labor costs. In September, I told you just how overdue this change is. That’s why we asked CMS to do it all at once rather than phase in the new math over four years, as the final rule does. We can already see that peeling away this particular Band-Aid slowly will elicit the same yelps from subspecialties we’d have heard had CMS ripped off the dressing. It’s another reason why we’re again stepping up our work with Congress to solve budget neutrality.

    In line with Academy advocacy, the final rule increases physician payments for routine vaccine administration (as we’ve consistently lobbied to secure) and chronic care management.

    The rule recognizes the importance of telehealth services beyond the public health emergency. It makes coverage of tele-mental health services in beneficiaries’ homes, including audio-only mental health services, permanent, cementing a lifeline for countless primary care patients. We’re pleased that the rule will allow federally qualified health centers and rural health clinics to continue offering telehealth services beyond the pandemic. Unfortunately, the rule does not entirely eliminate Medicare’s geographic and originating-site restrictions for all telehealth services or continue audio-only E/M visits beyond the PHE, but we’re continuing to press Congress for that result.

    Also last week came a unanimous recommendation by the CDC’s Advisory Committee on Immunization Practices to allow use of the Pfizer-BioNTech COVID-19 mRNA vaccine in children ages 5 to 11, followed by the Academy’s approval of the policy. Summing up what’s both historic and humane about this moment is a quote in a Nov. 2 New York Times story from AAFP member Pamela Rockwell, D.O., of Ann Arbor, Mich., our ACIP liaison. The story notes that the pandemic has “stalled routine immunizations, widened education gaps and escalated rates of anxiety and depression among children,” then gives the floor to Rockwell. “Vaccination of children ages 5 to 11 years will not only help prevent COVID-19 infection and serious consequences of infection in this age group, but will also help children emotionally and socially,” she told the paper.

    Finally, the administration on Nov. 4 detailed two new COVID-19 vaccination policies. The Academy joined numerous medical and specialty societies earlier this year in calling for action in this area, and we believe these rules are worthwhile tactics in halting the pandemic. They will affect some family medicine practices; the Academy summarizes them here.

    Your Turn

    Today we’ve launched a Speak Out campaign to let you directly lobby your members of Congress to avert Medicare pay cuts by increasing the 2022 conversion factor and to ensure that CMS’ update to clinical labor pricing proceeds without delay.

    I encourage you to join the Academy’s other Speak Out campaigns as well. Our advocacy works best when your voices are included, and they’re needed today as, among other efforts, we continue to call on governors to fully incorporate family physicians in every state’s plan to vaccinate children. 

    Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.


    Stephanie Quinn, AAFP senior vice president of advocacy, practice advancement and policy.  Read author bio »


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