CMA/AMA Successful in Getting Congress to STOP Physician Medicare Cuts December 11, 2021 General, Medicare Medicare Payment Cuts 0 U.S. Senate votes to stop nearly all of the Medicare payment cuts facing physicians for 2022 CMA has some good news to share on the federal front: Tonight the U.S. Senate voted to stop nearly all of the Medicare payment cuts physicians were facing on January 1, 2022. Earlier this week, the U.S. House of Representatives passed the legislation which included provisions to increase the debt ceiling – a must-pass bill for Congress and the nation. President Biden is expected to sign the bill before the debt ceiling deadline of December 18, 2021. Please also see the AMA message below. CMA warned Congress that physicians are still on the frontlines fighting the pandemic and their practices have not yet recovered. Most recently, CMA and CHA joined forces to urge the California Delegation to stop the Medicare cuts. See the December letter attached. CMA, the County Medical Societies, and physician leaders across the state met or contacted every Member of the California Delegation about these urgent and devastating cuts that would continue to destabilize physician practices. In response, nearly 250 Members of Congress sent a letter to House Leadership urging them to stop the payment cuts. CMA wants to thank the County Medical Societies, all physician leadership and the physician grassroots that were key to convincing Congress to intervene. CMA also appreciates the continued leadership of Speaker Pelosi and thanks Minority Leader McCarthy, Senators Feinstein and Padilla, and the California Congressional Delegation for their support. Brief Summary: Medicare Sequestration Cuts Waiver Extended - Extends the COVID-19 waiver of the 2% Medicare sequestration cuts through March 30, 2022; restores 1% of the Medicare sequestration cuts on April 1, 2022 and then on June 1, 2022 all of the Medicare 2% sequestration cuts will resume. (Note: 2% Medicare sequestration cuts were enacted in 2011 as part of a massive effort to reduce federal spending. All federal programs were cut.) 3.75% Medicare Fee Schedule Cut Reduced - Congress stopped 3% of the 3.75% Medicare Physician Fee Schedule cuts proposed by the Centers for Medicare and Medicaid Services. Some physicians will still experience a .75% payment cut. 4% PAYGO Cut Stopped - Congress fixed the PAYGO provision that would have imposed another 4% Medicare payment cut through 2022. Delayed the Radiation Oncology Alternative Payment Model Demonstration Project until 2023 - CMA will continue to advocate for its permanent elimination. Delayed the Clinical Laboratory Medicare payment cuts - the requirements to report on private rates until 2023. As the AMA message below from Dr. Harmon suggests, AMA, CMA and all of organized medicine must come together next year to propose proactive legislative reforms to the Medicare payment system to provide annual payment updates to keep pace with rising costs, eliminate unnecessary and harmful budget neutrality cuts, and promote physician-led alternative payment models. We must convince Congress to overhaul the Medicare payment system soon. Thanks again to the entire CMA team of physicians and staff for your assistance in stopping these massive Medicare payment cuts – that also impact Medicare Advantage and private sector rates. It should also be noted that Congress did this in record time this year avoiding yet another Christmas Holiday crisis! AMA-AHA Surprise Billing Litigation Filed Today In other news today, the AMA and the American Hospital Association (AHA) filed a joint lawsuit challenging the Biden Administration’s federal surprise billing regulations that heavily favor the powerful insurance industry and are in conflict with Congressional intent and the balanced law that Congress passed. Specifically, the challenge is related to the rebuttal presumption given to the median contracted payment rate as the appropriate out-of-network payment rate in the independent dispute resolution process. AMA and AHA have also asked for a stay of the independent dispute resolution process. The message and press release are listed below. See the CMA and AMA comments on the regulations attached. Build Back Better Social/Health Care Infrastructure Legislation Awaits Final Determination Finally, CMA will continue to advocate for the passage of the important health care provisions in President Biden’s Build Back Better social/health care infrastructure plan, including improvements to the Affordable Care Act, allowing Medicare to negotiate drug prices with pharmaceutical companies that will reduce prices by 40-65%, expanding the number of GME residency positions by 4,000, and including the new Pathways to Practice Program that provides scholarships and stipends to minority students who choose medicine as a career. The bill passed the House in early November and the final negotiations are underway in the Senate. MESSAGES FROM THE AMA: 1. SURPRISE BILLING LITIGATION The American Medical Association and American Hospital Association filed a complaint and motion to stay against the federal government today over the misguided implementation of the federal surprise billing law. What follows is the press release. Hospital and physician groups file lawsuit over No Surprises Act final rules that jeopardize patient access to care December 9, 2021 WASHINGTON —The American Hospital Association (AHA) and American Medical Association (AMA), representing hospitals, health systems, and physicians, sued the federal government today over the misguided implementation of the federal surprise billing law. The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health and two physicians based in North Carolina. The lawsuit challenges a narrow but critical provision of a rule issued on Sept. 30, 2021, by the U.S. Department of Health and Human Services (HHS) and other agencies. The provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients. The rule and this flawed provision are set to take effect Jan. 1, 2022. The AHA and AMA strongly support protecting patients from unanticipated medical bills and were instrumental in passing the landmark No Surprises Act to protect patients from billing disputes between providers and commercial health insurers. The legal challenge became necessary because the federal regulators’ interpretation upends the careful compromise Congress deliberately chose for resolving billing disputes. According to the lawsuit, the new rule places a heavy thumb on the scale of an independent dispute resolution process, unfairly benefiting commercial health insurance companies. The skewed process will ultimately reduce access to care by discouraging meaningful contracting negotiations, reducing provider networks, and encouraging unsustainable compensation for teaching hospitals, physician practices, and other providers that significantly benefit patients and communities. Congress created an independent dispute resolution process that is required when providers and insurers are unable to reach agreement on payment for out-of-network services from providers who are not under contract with the insurer. However, federal regulators have directed arbiters under independent dispute resolution to presume that the median in-network rate is the appropriate out-of-network rate and limiting when and how other factors come into play. The suit argues that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians, and other providers will routinely be undercompensated by commercial insurers and patients will have fewer choices for access to in-network services. Importantly, today’s challenge does not prevent the law’s core patient protections from moving forward and will not increase out-of-pocket costs to patients. It seeks only to force the Administration to bring the regulations in line with the law before the dispute negotiations begin. “No patient should fear receiving a surprise medical bill,” said Rick Pollack, AHA president and CEO. “That is why hospitals and health systems supported the No Surprises Act to protect patients and keep them out of the middle of disputes between providers and insurers. Congress carefully crafted the law with a balanced, patient-friendly approach and it should be implemented as intended.” “Congress established important patient protections against unanticipated medical bills in the No Surprises Act, and physicians were a critical part of the legislative solution,” said AMA President Gerald E. Harmon, M.D. “But if regulators don’t follow the letter of the law, patient access to care could be jeopardized as ongoing health plan manipulation creates an unsustainable situation for physicians. Our legal challenge urges regulators to ensure there is a fair and meaningful process to resolve disputes between health care providers and insurance companies.” Last month, a bipartisan group of 152 lawmakers urged the Administration to fix the independent dispute resolution provisions, noting the rule’s approach “is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law.” The AHA, AMA and their co-plaintiffs filed their lawsuit against the departments of HHS, Labor, and Treasury, along with the Office of Personnel Management in the U.S. District Court for the District of Columbia. For additional information, please see copies of the filed complaint and motion to stay. 2. Senate Passes Legislation to Halt Medicare Physician Payment Cuts This evening, the Senate passed legislation halt Medicare physician payment cuts that were scheduled to take effect on January 1. President Biden is expected to sign the bill into law. Highlights of the physician payment provisions include: • A delay in resuming the 2% Medicare sequester for three months (January 1- March 31, 2022), followed by a reduction to 1% for three months (April 1-June 30, 2022). • A one-year increase in the Medicare Physician Fee Schedule of 3% (0.75% less than the conversion factor boost provided for 2021). • A one-year delay in the cuts to the clinical lab fee schedule. • A one year delay in the Medicare radiation oncology demonstration. Additionally, the bill will erase the 4% Medicare PAY-GO cut and prevent any additional PAY-GO cuts through 2022. The AMA released the following statement on tonight’s Senate vote to avert looming Medicare cuts to providers. AMA: Patients and Physicians Grateful for Congress Fending Off Medicare Cuts December 9, 2021 Statement attributable to: Gerald E. Harmon, M.D. President, American Medical Association “The wheels of Congress don’t always move quickly, but today they did move toward preserving the viability of physician practices and maintaining access to care. “Potential reductions in Medicare payments for physician services hung over the heads of patients and practices like a sword of Damocles. The Senate action today, following a similar House vote this week, would delay the reductions and give Congress time to work on reforms to address the flaws in the Medicare payment system. “There is no need to wait for the last minute to start working on the systemic problems. These automatic cuts should remind members of the needed reforms. Congress can get a head start on doing the right thing when it reconvenes early next year.” Comments are closed.
