By Ronald Giffler
July 9, 2020 at 5:00 am ET
While many parts of the country look to turn the corner on their COVID-19 response, the virus itself still isn’t going away. In the face of this crisis, our nation’s doctors have remained on the front lines, risking their own health to care for patients. The pandemic has served as a humbling reminder that physicians’ work is both selfless and essential. It is critical that policymakers adopt policies that stand up for our doctors who are staring in the face of a global health and financial crisis.
The U.S. Department of Health and Human Services acted swiftly to direct emergency relief funds to health care providers. However, an upcoming pay cut directed by the Center for Medicare and Medicaid Services poses a new threat to doctors and our health care system at large.
During the height of the outbreak, non-COVID care was largely put on hold. Even when factoring in COVID hot spots, emergency rooms saw a 50 percent drop in patients across the country. Other specialties like anesthesia experienced decreases as high as 70 percent. While elective care is slowly coming back, the financial crisis caused by reduced patients visits is far from over. Many practices were forced to close their doors. Some of them might never open again. In April alone, 1.4 million health care workers lost their jobs, following an estimated 42,500 lost in March.
Congress has taken steps towards alleviating the crisis within health care, including targeted relief for health care providers under the CARES Act. This relief is timely and necessary: The health care industry saw its largest ever decline in the first quarter of 2020. As the country slid into recession, half of the overall GDP decline in the first quarter came from the health care sector.
There’s little question that the virus will ebb and flow in the months to come, and until a vaccine is developed, we are likely to face new outbreaks. Even if patient volumes eventually return to normal, that would likely be several months down the road. And just as doctors will be looking to turn the corner on the financial crisis, they will be facing another devastating cut in compensation: the federal government is scheduled to cut reimbursement rates for Medicare in January 2021.
CMS has adopted a rule that will shift how physicians are reimbursed for office and outpatient evaluation and management services. On one level, this proposed rule correctly recognizes that these services are undervalued and attempts to redress this problem by increasing the level of reimbursement tied to them. However, in accordance with federal law, these reimbursement changes must be made on a budget-neutral basis. This means that any reimbursement increase tied to specific services must be offset by cuts for other services.
Consequently, the new CMS rule will also cause many physicians to receive a substantial pay decrease. Specialties that CMS has projected will be adversely impacted by these cuts include, but are not limited to: anesthesiology, critical care, emergency medicine, gastroenterology, ophthalmology, pathology, radiology and most surgical specialties. And, at a time when many practices are struggling to stay in business, few such practices can afford a substantial decline in revenue.
Luckily, there is still time to support our doctors and prevent this ruling from going into effect.
Congress has the power to waive the budget neutrality requirement for E&M services in future COVID-19 legislative packages. Additionally, CMS still has time to work with the American Medical Association and the various specialty societies to settle on an alternative reimbursement methodology that properly recognizes the value of office and outpatient E&M services without threatening access to care.
With doctors already facing severe financial instability, legislative and regulatory action that supports their ability to continue providing care to patients is critical. And as we consider recovery post-COVID, we should be doing everything in our power to ensure that physicians are able to reopen their practices and that future patients still have a strong health system in place.
Our front-line doctors are doing their best to navigate an uncertain, previously unfathomable landscape. They’re risking their lives, sacrificing time with loved ones, and working nonstop to protect us.
It’s time to ask that policymakers return the favor.
Ronald Giffler, M.D., J.D., M.B.A., serves as president of the Florida Medical Association and is also president and CEO of FirstPath, a physician-operated lab based in Pompano Beach, and Medical Director of Laboratory Services for Broward Health, one of the nation’s largest public health systems.
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