November 15, 2021
5 minutes to read
Source / Disclosures
Neither Abraham, Harmon, Outland nor Ransone are reporting any relevant financial disclosures.
The CMS final rule regarding physician payment, clinical labor prices, intensive care services and telehealth services for fiscal year 2022 has received mixed reactions from medical groups.
Some of the elements of the rule exacerbate concerns over the COVID-19 pandemic while others alleviate them, the groups said.
Gains, losses in physician payments
CMS said the Medicare Part B rates doctors receive for each flu, pneumococcal and hepatitis B vaccine administered will increase from about $ 17 to $ 30.
Additionally, CMS said the current payment doctors receive for each dose of the COVID-19 vaccine they administer will remain $ 40 “until the end of the calendar year in which the [public health emergency] ends. “After that, the payment rate for each COVID-19 vaccine dispensed” will be set at a rate that aligns with the payment rate for the administration of other preventive Part B vaccines. “
CMS has also finalized its proposal to allow rural health clinics and federally qualified health centers to charge for chronic care management services, including transitional care management, which are provided “for the same. payee during the same period of service, provided that all billing requirements for each code are met. “
The American Academy of Family Physicians applauded these decisions.
Sterling N. Ransone, Jr.
“For decades our primary care system has been strained, underfunded and understaffed – COVID-19 has only exacerbated these challenges. We are pleased that CMS has recognized this historic undervaluation and is once again taking action to address it by increasing payment rates for vaccine administration and chronic care management services, ”said the chairperson of the ‘AAFP. Sterling N. Ransone, Jr., MD, FAAFP, said in a statement from the academy.
The CPA said it was “extremely concerned about the general cuts to physician payments that will take effect in early 2022”.
“The proposed cuts are the result of a legally required cut that is necessary to maintain the budget neutrality of Medicare payments,” ACP said in a statement released by the college.
Congress can stop ‘financial peril’ doctors face at the end of 2021, WADA president Gerald E. Harmon, MD, said in a statement from the association. Overall, there could be a 9.75% reduction in Medicare physician payments for 2022, he said.
Gerald E. Harmon
“This comes at a time when medical offices are still recovering from the personal and financial impacts of the COVID public health emergency,” he added. “WADA strongly urges Congress to avoid this.”
Ransone also urged Congress to “mitigate impending Medicare cuts that are hurting physician practices.”
ACP President George Abraham, MD, FACP, said it will be important “to ensure that practices across the country can continue to function and provide primary care that improves health equity and patient access in their communities.”
First rise in labor prices since 2002
The final rule also includes the first update in nearly 20 years of clinical labor rates that are used to determine practice spending, CMS said. Many healthcare professionals will see their compensation increase over the next 4 years for every minute they perform tasks.
- opticians, who currently earn 33 cents per minute for certain tasks, will be paid 35 cents per minute next year and 39 cents per minute in 4 years;
- audiologists, who currently earn 52 cents per minute for certain tasks, will be paid 59 cents per minute next year and 81 cents per minute in 4 years;
- physiotherapy assistants, who currently earn 39 cents per minute for some tasks, will be paid 45 cents per minute next year and 61 cents per minute in 4 years;
- registered dietitians, who currently earn 47 cents per minute for certain tasks, will be paid 53 cents per minute next year and 70 cents per minute in 4 years; and
- orthoptists, who currently earn 37 cents per minute for certain tasks, will be paid 47 cents per minute next year and 76 cents per minute in 4 years.
“This critical update will allow physician offices to hire and retain nurses, physician assistants and other full members of the healthcare team as it is implemented,” said Ransone.
Brian Outland, Doctorate, CPA’s director of regulatory affairs, told Healio Primary Care that “clinical work is at risk of being undervalued over time relative to equipment and supplies.”
“ACP was pleased to see that CMS finalized its proposal to update clinical workforce pricing for 2022,” he said.
ACP also said that phasing in these payment increases “will help ensure the stability of payments and maintain beneficiaries’ access to care”.
Critical care services
The final rule helps clarify “long-standing policies” regarding critical care services, CMS said.
Subject to certain conditions being met, intensive care services can be reimbursed on the same day as other assessment / management visits “by the same practitioner or another practitioner in the same group of the same specialty” and “paid separately. in addition to an act with a global surgical period, ”said CMS.
Outland said some of the clarifications stem from comments the ACP provided to CMS during the rule’s comment period.
“ACP was deeply concerned about the policy proposed by CMS in this context, and we are extremely happy to see that CMS listened to the feedback we have given them,” he said.
He added that “these policies are important because seriously ill or injured patients require complex care which is often extremely difficult to manage and takes time.”
“These changes will allow the work of clinicians to be appropriately remunerated as a separate service and are a step in the right direction towards adequate recognition of the value of these services,” he said.
“Significant progress” in telehealth
CMS said the final rule allows counseling, therapy and treatment of substance use disorders and services offered in opioid treatment programs through audio-only phone calls.
In addition, and for the first time outside of the COVID-19 public health emergency, Medicare will reimburse mental health visits made by rural health clinics and federally approved health centers using health care technology. telecommunications such as audio-only phone calls, according to CMS. .
“The Final Rule makes significant progress in expanding access to behavioral health care, especially for traditionally underserved communities,” CMS said.
Ransone said he was “encouraged” by the telehealth elements of the Final Rule, but further reform is still needed.
“These services have been a lifeline for many beneficiaries during the pandemic,” he said. “The AAFP looks forward to working with Congress and the administration to ensure continued coverage and equitable payment for comprehensive primary care services via telehealth, including audio-only visits, after the end of the health emergency. public. “
Outland said the CPA was also “happy to see these increased flexibilities… but we remain disappointed that assessment / management services outside of mental health services have not been included”.
The 2022 Medicare Physician Fee Schedule represents a step toward prioritizing primary care and family medicine. https://www.aafp.org/news/media-center/statements/2022-Medicare-Physician-Fee-Schedule.html. Posted November 3, 2021. Accessed November 9, 2021.
WADA Statement on Final Rule for Physician Fee Schedule. https://www.ama-assn.org/press-center/press-releases/ama-statement-physician-fee-schedule-final-rule. Posted November 2, 2021. Accessed November 9, 2021.
AMA. Congress should not take Medicare salaries from physicians to build bridges. https://www.ama-assn.org/practice-management/medicare-medicaid/congress-must-not-take-physicians-medicare-pay-build-bridges. Posted July 27, 2021. Accessed November 9, 2021.
CMS. Health insurance program; CY 2022 payment policies under the Physician Fee Schedule and other changes to Part B payment policies; Medicare Shared Savings Program Requirements; Regulatory updates on supplier registration; and the supplier’s and supplier’s medical examination requirements for prepayment and post-payment. Posted November 2, 2021. Accessed November 9, 2021.
CMS. 3 Final payment rules. Posted November 2, 2021. Accessed November 9, 2021.
CMS. 2022 Medicare Calendar Year (CY) Physician Fee Schedule Final Rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule. Posted November 2, 2021. Accessed November 9, 2021.
Internists say the Medicare 2022 fee schedule includes positive changes for physicians. https://www.acponline.org/acp-newsroom/internists-say-2022-medicare-fee-schedule-includes-positive-changes-for-physicians. Posted November 3, 2021. Accessed November 9, 2021.