CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which could result in drastic cuts for surgeons across the board.
If approved, the conversion factor would drop from $36.09 to $32.26, and would affect most surgical specialties.
Here Leaders from five professional organizations shared reactions to the news and spoke about what the cuts could mean for surgeons.
Note: Responses were edited for style and content.
David Glasser, MD, secretary for federal affairs of the American Academy of Ophthalmology: "It's as if the last five months didn't happen. CMS is asking the specialty that took the economic brunt of the pandemic and took massive code decreases this year to also take the brunt of planned pay cuts in 2021. There is no way that these pay cuts won't affect Medicare patients' access to timely surgical care."
David Hoyt, MD, executive director of the American College of Surgeons: "What Medicare reimburses surgeons does not completely cover costs. There are types of insurance that pay even less, like Medicaid, but the way a physician makes their living is to [see all those patients] in aggregate, and there is a point where you can't recover enough in aggregate to cover your cost. [When that happens,] you then have to eliminate staff or you may limit the access [that Medicare and Medicaid] patients have to your practice. There are absolutely surgeons around the country that don't take Medicare patients right now. Cutting reimbursement even more will only make that worse.
"Right now, surgeons are coming out of, slowly, a significant form of [a shutdown]. … We did a survey of 5,000 surgeons in private practice, and one-third of them were considering whether they'd stay in practice, and 50 percent had to make a decision to either limit their income or cut or furlough employees in their practice. That was before these cuts, so this is only going to get worse.
"[In response,] we're asking for Congress to waive budget neutrality. The reason [these cuts] have occurred is if they adjust the fees for other physicians or services, which can be very appropriate, they have to cut other services. One of the drivers [for CMS] was to make sure the reimbursement for primary care services including physicians can be increased, and [the agency proposed doing it it] by having to cut other services. Surgical fees weren't the only thing that were cut. That's the problem.
"The most important thing [physicians can do] is to share how this might affect their patients. We don't want to scare patients at all, but we want people to understand why we're upset. It's important to understand this. This is sending a message to surgeons, who all they want to do is take care of patients, and they're working harder than ever to catch up [from COVID-19-related shutdowns]. To send a message to them now, that they're going to cut reimbursement by 10 percent, is not the right thing to do."
Samuel Jones, MD, chair of the American College of Cardiology Health Affairs Committee: "... While the ACC supports changes that recognize the increased work of managing complex patients, it is disappointing that [CMS] continues to ignore recommendations from the ACC, the American Medical Association and other medical societies to adjust [relative value units]for global surgery services commensurate with increases to [evaluation and management] services. This shortcoming disruptively amplifies the reallocation of resources across specialties that ensues through required budget neutrality."
Matthew Sideman, MD, chair of the Society for Vascular Surgery Policy and Advocacy Council: "We were anticipating these cuts in the conversion factor and have expressed concern since first learning about them. Unfortunately, they are even worse than expected, and tone deaf to what has happened to healthcare during COVID-19. Everyone has been hit hard by the pandemic. Surgeons answered the call to fight the spread of the virus and canceled elective surgeries. While some physicians have been able to adapt with telehealth, there is no 'telesurgery.' Cutting reimbursement now will only make healthcare harder to access, particularly for our most vulnerable population, the elderly. The solution is clear: Congress must pass legislation that will waive the budget-neutrality requirement that is at the heart of these devastating cuts. As members of the Surgical Care Coalition, we proposed this very resolution in June, and we hope Congress will act quickly."
Ann Stroink, MD, chair of the American Association of Neurological Surgeons: "This was an ill-informed and dangerous policy for patients even before the pandemic started but could be even more detrimental as our healthcare system continues to weaken under COVID-19. If finalized, this proposal could result in neurosurgeons taking fewer Medicare patients, leading to longer wait times and reduced access to care for older Americans, so Congress must act now to prevent this from happening."
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