ASPS Advocacy Successfully Stops Disastrous Medicare Cuts
From the August 3 introduction of a controversial proposed rule by CMS that cut the 2021 Medicare E/M payments for plastic surgery by approximately 7 percent and the passage of federal legislation reversing those cuts, ASPS actively opposed the measure through a comprehensive advocacy strategy focused on requests to both CMS and Congress to hold physicians harmless. ASPS relentlessly urged leaders to stop these harmful cuts, demonstrating the breadth of the Society's commitment, expertise and policymaking contribution through ASPS-led comments, physician grassroots initiatives, Congressional meetings and coalition outreach with the Surgical Care Coalition.
Background
On August 3, CMS introduced a proposed rule in which physicians would see a reduction to the conversion factor of more than 10 percent – from $36.09 in 2020 to $32.26, effective January 1, 2021. The proposed Medicare Physician Fee Schedule cuts were poised to deal a devastating blow to both physicians and patients at a time when practitioners are facing increased financial strain due to the ongoing COVID-19 public health emergency.
Focused and ongoing opposition
Upon introduction of the proposed rule, ASPS immediately voiced its opposition and provided specific recommendations on how to strengthen the rule in a letter to CMS Administrator Seema Verma. The Society also activated four physician grassroots campaigns – three to Congress and one to CMS – urging lawmakers and CMS officials to stop the cuts.
Stopping the proposed Medicare cuts was also one of the top legislative asks during the Society's Northeast & Midwest Virtual Regional Fly-In in September 2020. In virtual meetings, physicians urged members of Congress to waive the budget neutrality requirements for the Medicare PFS, implement positive payment updates for 2021 and 2022 and direct CMS to apply the 2021 increases in values for office and outpatient evaluation and management (E/M) services to the E/M component of 10- and 90-day global codes.
On October 30, legislation was introduced by Larry Bucshon (R-IN-08) and Ami Bera, MD (D-CA-07) that included a hold harmless provision preventing the anticipated 7% cut to plastic surgery. This bill was the product of significant input and negotiations by ASPS staff and coalition partners representing other specialties. The legislation was a significant step in the ongoing fight against the proposed cuts and served as placeholder legislation that helped influence the Medicare payment provisions in the end-of-the-year spending package that would follow.
To bolster support for a legislative fix, ASPS participated in coalition outreach with the Surgical Care Coalition, Alliance of Specialty Medicine, and other specialty physician groups – such as the American College of Surgeons and the American College of Radiology – to demand fair Medicare reimbursement for specialty physicians before the end of the 116th Congress.
In December, ASPS joined coalition calls focused on moving Congress to address the upcoming 2021 Medicare payment cuts in their end-of-year package. The Society also sent a letter to every US House and Senate office further stressing the importance of addressing the planned cuts in the pending relief package.
The Society's efforts came to fruition on December 21, when Congress passed an end-of-the-year spending package, including a $1.4 trillion omnibus spending bill and a $900 billion pandemic relief bill. Notably, the package mitigated the proposed Medicare physician payment cuts.
A key victory for ASPS
The end-of-year law passed by Congress includes $3 billion to help offset the CY 2021 Medicare Physician Fee Schedule (PFS) cuts that were planned to take effect on January 1, 2021.
Plastic surgery was originally scheduled to see a 7% cut under the new fee schedule. The relief package will provide physicians with a 3.75% increase and also halt the implementation of the G2211 (formerly GPC1X) code for three years, which could nearly eliminate the planned 7% cut to plastic surgeons for one year. Additionally, Congress enacted a 3-month delay of Medicare sequestration cuts that were scheduled to begin January 1, 2021. These actions result in the avoidance of a planned 2% cut to Medicare payments during the first quarter of 2021.
This victory was a demonstration that physicians do have true political power and that strengthened collaboration produces better results. A special thanks is owed to all of the ASPS members who contacted legislators, participated in meetings and used their voice to raise concerns and join ASPS in the fight against the cuts.