Tuesday afternoon, the Centers for Medicare & Medicaid services (CMS) released the final Part B program for 2022 called the Physician Fee Schedule Final Rule that contains final payment rates for CPT codes in 2022 and other Part B policy matters such as quality reporting and MIPS. As was proposed in July, this CMS regulation has a deep impact on office-based vein care reimbursement, because of changes in how the CMS office based payment formula is being adjusted.

Notes from the Final Rule:

Unfortunately, but predictably, the change in the office-based payment formula motivated by CMS’s update to the Clinical Labor rates that was fueling a steep drop in payment for many venous will be PHASED IN over four years starting in 2022. AVLS had asked that CMS retract this proposal, and to avoid a four year phase in.

From CMS:

“Although we recognize that payment for some services will be reduced as a result of the pricing update due to the BN requirements of the PFS, we do not believe that this is a reason to refrain from updating clinical labor pricing to reflect changes in resource costs over time as suggested by some commenters. There are also other services, such as those primarily furnished by family practice and internal medicine specialties, that will be positively affected by the pricing update, which we anticipate will increase access to care for disadvantaged groups such as women and racial minorities.”

CMS goes on to say:

“We believe that the use of a 4-year transition in implementing the clinical labor pricing update will help to maintain payment stability and mitigate potential negative effects on healthcare providers by gradually phasing in the changes over a period of time. We believe that this transition period is also important given that the PHE for COVID-19 is ongoing and industry recovery is likely to take time.”

The other statutory payment factors that CMS has no recourse but to implement are:

• Expiration of the current reprieve from the repeatedly extended 2 percent sequester stemming from the Budget Control Act of 2011. Congress originally scheduled this policy to sunset in 2021 but it will now continue into 2030.
• Imposition of a 4 percent Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO.
• Expiration of the Congressionally enacted 3.75 percent temporary increase in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustments tied to PFS policy changes.
• A statutory freeze in annual Medicare PFS updates under the Medicare Access and CHIP Reauthorization Act (MACRA) that is scheduled to last until 2026, when updates resume at a rate of 0.25% a year indefinitely, a figure well below the rate of medical or consumer price index inflation.

The AVLS Advocacy Committee and our consultants are currently reviewing the entire final rule and will explain it in detail at the webinar on November 10 at 8:00 PM EST. We will also address the next steps as a Society and how you can get involved.

Read the Final Rule here.

Register for the free webinar here.

Dr. Sreenivas Reddy, an AVLS member from Illinois, joined U.S. Representative Danny K. Davis at a press conference at the Chicago Medical Society to oppose the proposed CMS cuts along with Dr. Tariq Butt, President of the Chicago Medical Society, Dr. Paramjit “Roma” Chopra, an Interventional Radiologist, and Dr. Dominic Tolitano, Thoracic and Vascular Surgeon. 

“The proposed Medicare payment changes will sharply limit access to care to most underserved communities and populations,” said Dr. Reddy. “It will delay their care and force these patients into overburdened hospitals.”

The discussion centered on the loss of more affordable healthcare procedures and a shift to hospital care if office-based care is forced to close. 

“Medicare is one pot, fixed, and anytime we take out from it, it has to come from somewhere else,” said Dr. Chopra. “Now, in this fixed pot, we have to make sure that our care is better, faster and cheaper. The outpatient services are as much to 50-70% cheaper in the office than in the hospital. Now, if they cut 20%, then I know for certain, the three clinics that I have won’t be able to survive.”

Closing office-based care would shift these patients into hospitals already overburdened by the pandemic for procedures that would cost up to 3x more in the hospital setting than as office-based, outpatient procedures, said Dr. Chopra. 

Additionally, Dr. Chopra shared how his diabetic patients may have to wait six weeks to be seen at a hospital, and that delay can result in limb amputation. Once a diabetic patient has received an amputation, there is a 50% likelihood of dying in the next three years. Alternatively, his clinic is often able to see these patients the next and provide care that can save the limb and extend his patients’ quality of life. 

“If you take care of people at different stages of being, then they don’t get to the last stage, where you might have to use a lot of resources just to keep them ok for a short period of time, like ventilators and end of life care,” commented Rep. Davis. 

Dr. Tolitano added that the proposed cuts are untenable for many office-based practices. This will result in many practices no longer being able to afford procedures, as no business can survive a 20% cut. 

“It is my feeling that regulatory policies should be designed to increase access to care and facilitate service,” closed Rep. Davis. “Office-based practice is an essential part of healthcare delivery in this country and should be protected.”

The conference was attended by physicians from around the Chicago area, including Vein Clinics of America, medical students, the Illinois Department of Public Health, and the Access Community Health Network.

The AVLS encourages its members to reach out to their Congressional representatives as Dr. Reddy did and engage them in conversations about this topic. Resources are available at www.myavls.org/cms22, or for additional support, contact Robert White at advocacy@myavls.org.

Watch a livestream of the conference.