January 10, 2022, 8:38 a.m. — Let me start the new year by giving you some excellent news. Thanks to the Academy’s stalwart advocacy, Congress capped 2021 by passing legislation to support primary care practices and help family physicians better care for our patients through the pandemic’s latest surge.
The bipartisan Protecting Medicare and American Farmers From Sequester Cuts Act (S. 610) postponed a series of Medicare payment cuts that would have begun taking effect last week. The AAFP lobbied for this legislation, and we recognize its enactment as a major win for our members, one that brings some financial stability just as the omicron variant again emphasizes the need for comprehensive primary care.
Certainly this comes as a relief to me, a Deltaville, Va., family physician whose staff and patients are affected by Medicare policy. I know that some primary care practices had been considering limits on the number of Medicare patients they see. Now, practices such as mine are starting the year reassured that we’ll be able to keep treating all of our patients, building trust in our communities as we work to get to the other side of the public health crisis.
In fact, S. 610 positively affects Medicare payments for family physicians in multiple ways.
In accordance with S. 610’s implementation, CMS has updated its 2022 Medicare physician fee schedule conversion factor (that is, the amount Medicare pays per relative value unit) to $34.6062. The new number is less than the 2021 conversion factor ($34.8931); thankfully, however, it’s more than the conversion factor of $33.59 noted last fall in CMS’ 2022 Medicare physician fee schedule final rule. Guided by S. 610, the updated conversion factor is newly visible in spreadsheets on the agency’s website.
Using the new conversion factor and accounting for other changes directed by S. 610, family physicians will see no change in their total Medicare allowed charges in the first quarter of 2022, according to AMA estimates. This is another AAFP win: a substantial improvement over the -8.7% change that loomed before S. 610 passed.
I also can’t overstate the importance of something S. 610 did not do: set aside the increase to clinical labor pricing built into the 2022 Medicare physician fee schedule final rule. As I recently told you, this boost marks the first time in two decades that the agency has moved to correct the longstanding payment distortions between primary and select specialty care stemming from outdated wage data. It’s a huge win for the Academy that S. 610 addressed Medicare payment without halting this essential improvement — particularly when fewer than 30% of primary care physicians say their practices are on solid financial footing and close to half of primary care practices have seen clinician turnover, limiting their ability to care for patients.
Unfortunately, S. 610 hasn’t silenced certain subspecialist groups that continue to oppose this hugely beneficial clinical labor pricing update. These clinicians recognize, as we do, that budget neutrality is what Congress ultimately must correct in order to solve Medicare physician payment. But they incorrectly assert that Medicare pay reductions for some specialty services resulting from this badly needed clinical labor pricing correction (to be phased in over four years) threaten patients. A coalition of affected professionals takes the doomsaying a step further, insisting (without citing research) that this recognition of modern and appropriate clinical labor pricing will most hurt Black, Latino and other minority patient populations. In fact, the gaps in care experienced by communities of color are most likely to be reduced in primary care settings, which is why the Academy is leading the push to improve health equity.
This coalition’s false narrative is fueling a new lobbying focus: asking Congress to use the next appropriations bill (replacing the one set to expire on Feb. 18) as a means of halting the labor pricing change.
That would be bad policy: disruptive to the relativity of the fee schedule, destabilizing to physicians and truly harmful to patients, particularly patients of color. So we’re working to counter this attack as we renew our engagement with primary care’s allies in Congress. Again, the enemy is budget neutrality, not clinical labor pricing. That’s why all physicians need lawmakers to pass comprehensive reform of CMS policy this year.
With that call to action in mind, I’m once again asking you to add your voice to this imperative. Use the link below to remind your members of Congress that practices such as yours and mine are the backbone of our health care system. We work to keep our patients healthy on the front lines, diagnosing and treating, long term, the multiple conditions for which subspecialists are not our patients’ initial points of contact.
I’m proud that our Academy helped pass S. 610. The cuts averted by this legislation could have squeezed practices like mine out of business, stranding patients in a perilous time. As we begin the careful work of turning this latest reprieve into true, comprehensive reform, we must push back together against a shortsighted and panicky ambush. Join the AAFP’s Speak Out campaign to support the Medicare clinical labor pricing update.
Sterling Ransone, M.D., is president of the AAFP.