The following is a press release from the ACR that came out today.
The American College of Rheumatology (ACR) applauds the 247 Members of Congress who signed a letter urging Congressional leadership to address several cuts that would reduce Medicare reimbursements for health care providers by nearly 10 percent starting Jan. 1, 2022. These cuts would severely impact rheumatology practices already straining to recover from the COVID-19 pandemic, potentially jeopardizing patient access to care.
“The ACR thanks Reps. Bera and Bucshon, and all the other members of Congress who are calling on Congressional leadership to address the looming ‘Medicare cliff,’” said David Karp, MD, PhD, president of the ACR. “Extending physician payment adjustments for an additional year will help maintain providers’ operational stability that is still affected by the pandemic and ensure people living with rheumatic diseases do not see their care disrupted.”
Spearheaded by Representatives Ami Bera (D-CA) and Larry Bucshon (R-IN), the letter calls on Congress to addresses the imminent payment cuts stemming from an expiring adjustment to the Medicare Physician Fee Schedule (PFS) as well as the Medicare sequester and the Statutory Pay-As-You-Go (PAYGO) Act that cumulatively would cut reimbursements by a total of 9.75 percent next year.
The letter also calls for a future effort to establish broader, long-term reforms to ensure stability within the Medicare payment system as well as adequately incentivize high-quality care. Noting that the Physician Fee Schedule has failed to keep up with inflation over the years, the lawmakers argue that cuts to specialty providers could seriously jeopardize the stability of America’s health care delivery system at a time when so many providers are still only beginning to recover from the disruption caused by COVID-19.
Background on the “Medicare Cliff”
The looming payment cuts, which have been colloquially referred to as the “Medicare Cliff” stem from a confluence of three separate provisions that are all set to be implemented at the same time.
At the end of 2020, Congress attempted to mitigate the financial impact of the pandemic on health care providers by including a one-time 3.75 percent payment increases for all PFS services in the Consolidated Appropriations Act of 2021. This payment adjustment afforded some short-term stability for health care professionals struggling with the impact of the COVID-19 pandemic but is expiring at the end of the calendar year while providers still struggle with COVID’s impact.
At the same time, providers are also facing a 2 percent cut due to the expiring moratorium on the Medicare sequester. The sequester – which automatically cuts Medicare spending across-the-board – has been in place since 2013 but has almost always been suspended by Congress. The current suspension expires at the end of this year.
Finally, providers are facing an additional 4 percent payment cut due to the Pay-As-You-Go (PAYGO) budget rule, which requires mandatory spending increases to be offset by tax increases or cuts to other areas of mandatory spending. Because the American Rescue Plan that Congress passed earlier this year did not include such an offset, the PAYGO rule will be triggered unless Congress decides to waive it.