AMGA Pushes Congress to Prevent 10% Medicare Payment Cut


The industry group urged lawmakers to stop proposed cuts to Medicare payment for physicians as outlined in recent legislation and regulation.

Medical groups are urging Congress to prevent significant cuts to Medicare payment that could be triggered by recent spending bills and a proposed rule from CMS.

In a letter to Congressional leaders, AMGA (American Medical Group Association) is seeking to stop potential cuts from eliminating Medicare Pay-As-You-Go (PAYGO) reductions, delaying Medicare sequestration cuts, and finalizing a decrease in the Medicare conversion factor. In total, the industry group estimates the potential cuts to total about 10 percent of medical group reimbursements over the next year.

“With the total impact of this continuing pandemic unknown, it is critical that our members remain stable to provide optimal care. Now is not the time for providers to face a significant cut to Medicare reimbursement,” Jerry Penso, MD, MBA, AMGA president and CEO, stated in a press release.

Most medical groups and integrated health systems experienced revenue losses of 25 percent or more at the start of the pandemic in 2020, according to an earlier report from AMGA. Of those organizations, nearly 40 percent of the medical groups and 20 percent of the integrated health systems belonged to the “or more” category, with leaders reporting monthly revenue losses of over 50 percent.

The road to financial recovery has been rocky for healthcare providers since then, and it has only gotten harder to predict revenue and volumes because of the resurgence of the virus due to the Delta variant.

Enacting the Medicare payment cuts could threaten access to care during this difficult time, AMGA wrote in the letter. The group asked Congress to “clear the PAYGO ‘scorecard’ resulting from passage of the American Rescue Plan and ensure no further PAYGO cuts occur this year,” as well as approve legislation suspending next year’s sequestration and increasing the conversion rate in the Physician Fee Schedule by 3.75 percent.

Last year, Congress allowed CMS to increase all Medicare payments to physicians by 3.75 percent to offset a change in the Physician Fee Schedule’s conversion factor. The change was prompted by changes to evaluation and management (E/M) codes. CMS has proposed to reduce the conversion factor by 3.75 percent in 2022 to account for the E/M changes.

AMGA also advised Congressional leaders to promote telehealth services to maintain access to care.

“On telehealth, Congress and CMS acted quickly during the pandemic to enable AMGA members to reach patients in unprecedented ways, and we thank them for their leadership. Our members’ patients now have come to expect telehealth services as a standard offering. We ask Congress to ensure that this service remains available to all patients,” Penso explained.

Congress should make permanent certain flexibilities granted during the pandemic, including expanding the number of services that qualify for telehealth, waiving Medicare’s originating site and geographic limitations, and increasing Medicare reimbursement for telehealth services.

“[P]olicymakers need to ensure that payment parity between telehealth services, including audio-only services and in-office visits, continues beyond this pandemic,” Penso wrote in the letter.

Standardized federal licensing and credentialing for telehealth would also ease the burden of providing these now popular services, he added.

Additionally, AMGA publicly support Medicare Advantage and urged Congress to enact policy changes to the program that would preserve access to these benefits.

“MA structure supports the team-based, multispecialty medical group and integrated delivery system approach, resulting in the right care at the right time,” Penso wrote. “Congress should carefully consider any MA policy changes to ensure that they do not negatively impact care, which can disproportionally affect minority beneficiaries and those with social risk factors, as those beneficiaries are served more by MA plans than by traditional Medicare fee-for-service.”

The other issue highlighted in the letter to Congressional leaders included providing a “pathway to value.”

“Both Congress and the administration have made clear the necessity of transforming the way health care is financed and delivered,” Penso explained. “Policymakers must address significant obstacles and challenges that exist in the healthcare market so that AMGA members can continue providing high-quality, cost-effective, and patient-centered medical care.”

The industry group suggested that Congress back several bills, including the Seniors’ Chronic Care Management Improvement Act of 2021 (H.R. 4755), which would waive coinsurance requirements on chronic care management codes, and the Value in Health Care Act of 2021 (H.R. 4587).

Several leading industry groups, including the American Hospital Association (AHA), American Medical Association (AMA), and the National Association of ACOs (NAACOS), have also pledged their support for the Value in Health Care Act of 2021.

In a joint letter to Congress last month, a coalition including these groups and others said the bill ensures value-based care and payment models “continue to produce high quality care for the Medicare program and its beneficiaries as well as to generate savings for taxpayers.”

Among the reforms included in the bill are increasing shared savings rates in the Medicare Shared Savings Program, extending the five percent Advanced APM incentive payment, and fixing the “rural glitch” in Medicare’s largest model.

AMGA supported these changes in its letter to Congressional leaders and asked for more access to data to support value-based care efforts.

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