Protecting Patient Access to Office-Based Specialty Care
Op-Ed: CMS must eliminate cuts and reform the Physician Fee Schedule
By Dr. Mark Garcia, United Specialists for Patient Access (USPA)
Board Member and Health Policy Advisor
Last month, the 2022 Medicare Physician Fee Schedule was issued and the flawed PFS methodology paints a bleak picture for patients.
The Centers for Medicare & Medicaid Services (CMS) proposed a rule change that, if adopted, would result in a 20% across-the-board cut. As currently constituted, the Physician Fee Schedule (PFS) contains proposed cuts that will significantly and adversely affect a broad array of office-based specialists; for example, cardiology, interventional nephrology, interventional radiology, physical therapy, phlebology, radiation oncology, radiology, vascular surgery, and many more services that free-standing medical facility patients depend on.
The driver of these cuts is the flawed so-called “budget-neutrality” requirement – a misnomer of the highest order – which dictates that first order updates to PFS data cause indiscriminate factor decreases elsewhere and, consequently, drastic reductions in payments. These concerns stem from CMS implementing the clinical labor policy. The new clinical labor data results in massive cuts of more than 15 to 20 percent to critical services in the PFS. And with these cuts, it is the patients who are feeling the pain—make no mistake about it.
Many stakeholders, including the United Specialists for Patient Access (USPA), a coalition of practitioners and affiliated entities involved in providing front-line, office-based specialty care, are concerned that these cuts will continue to exacerbate the deterioration of quality healthcare delivery to the patient. It also will result in increased Medicare spending and likely lead to higher Medicare premiums and deductibles.
These cuts also disproportionately impact people of color, as many of the services affected by these cuts will strike the Black, Latino, and other minority communities the hardest.
But, accessible, affordable, and comprehensive healthcare for Americans should not be a zero-sum proposition. Both physicians and patients deserve more than that. With these cuts, the impact is both obvious and devastating. It's why 75 members of Congress have signed a bipartisan letter led by Rep. Bobby Rush (D-IL) and Rep. Gus Bilirakis (R-FL) asking CMS to abandon these proposed cuts.
In order to control patient flow and increase market share, large hospital systems are gobbling up physician networks and office-based specialists. The bad news, of course, is that consolidation ultimately limits competition and drives up health care costs, leaving the patient to foot the bill for the increase in costs for the services they receive from doctors and hospitals. The harsh reality is that small healthcare providers and office-based providers can't stay in business with inadequate reimbursement rates from the federal government.
The time for action is now. Tell CMS to eliminate the cuts and work on fundamental reform of the Physician Fee Schedule.
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Dr. Mark Garcia is an award-winning vascular and interventional radiologist who received his Masters Degree from the University of Illinois and his Doctor of Medicine from Thomas Jefferson Medical College. He brings with him years of experience in publishing academic articles and research, conducting clinical trials and providing quality care to patients. He currently serves as the chief medical officer at American Vascular Associates.