61 healthcare groups urge Congress to support implementing the physician fee schedule

November 17, 2020

American College of Rheumatology Calls the Bipartisan Legislation a "Win-Win" for All Medical Specialties

ATLANTA - Today, more than 60 healthcare stakeholders, representing Medicare providers, signed a letter urging congressional leaders to support bipartisan legislation that would implement the Centers for Medicare and Medicaid Service's (CMS) Calendar Year 2021 Medicare Physician Fee Schedule (MPFS) final rule as written, and provide for a one-year waiver of budget neutrality adjustments to avoid payment reductions to providers during the COVID-19 public health emergency.

If enacted, H.R. 8505 , which was introduced by Representatives Michael Burgess (R-TX) and Bobby Rush (D-IL), would ensure that long overdue rate increases for evaluation and management (E/M) services provided by rheumatologists, neurologists, and other cognitive specialists under Medicare - as finalized by CMS in its final rule - would not lead to rate cuts to other medical specialties or to physical and occupational therapists, many of which are an integral part of the rheumatology patient care team. This is a legislative solution that meets the needs of all stakeholders by allowing CMS to implement the final rule, on schedule, while funding offsets to the reimbursement reductions using funds allotted for provider support during the public health emergency.

"H.R. 8505 is a win-win solution for all medical specialties, and we encourage congressional leaders to swiftly pass this legislation," said David Karp, MD, PhD president of the American College of Rheumatology (ACR), the group leading the letter. "Current E/M reimbursement rates suppress patient access to diagnosis, treatment, and health maintenance at a time when demand for care is increasing. If this dire situation is not addressed as planned in the MPFS, then patient access to care will continue to decline."

In 2018, CMS proposed a code collapse that would have resulted in significant cuts to rheumatology care provided to Medicare beneficiaries. But after hearing the concerns raised by the patient and specialty provider community, CMS finalized a new proposal that reflects the recommendations of the American Medical Association, the ACR and over 170 other specialty societies and state medical associations. When enacted, the new rule will provide long overdue updates to Medicare reimbursement for time-intensive healthcare services including examinations, disease diagnosis, risk assessments and care coordination.

"The E/M improvements that will go into effect in January 2021 are critical to the continued delivery of high-quality rheumatology care for millions of Medicare beneficiaries," said Karp. "Budget neutrality via H.R. 8505 is a fair and reasonable approach to ensure these needed updates are not made at the expense of other specialties."
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The American College of Rheumatology (ACR) is an international medical society representing over 8,500 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.

American College of Rheumatology

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