Day: December 8, 2021

Congress moves to tackle Medicare physician pay cliff

/ Kevin B. O'Reilly

There appears to be a pathway emerging in Congress to address a combined 9.75% in Medicare physician payment cuts, which amount to a physician payment cliff and were set to take effect Jan. 1, 2022.

The Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was considered by the House of Representatives. While the underlying bill is the Senate-passed Dr. Lorna Breen Health Care Provider Protection Act, the House passed its version of that bill separately under suspension of the rules.

Highlights of the physician-payment provisions include:

  • A delay in resuming the 2% Medicare sequester for three months (Jan. 1–March 31, 2022), followed by a reduction to 1% for three months (April 1–June 30, 2022).
  • A one-year increase in the Medicare physician payment schedule of 3%, which is 0.75% less than the conversion factor boost provided for 2021.
  • A one-year delay in the cuts to the clinical laboratory payment schedule.
  • A one-year delay in the Medicare radiation oncology demonstration.
  • Erasing the 4% Medicare pay-as-you-go (PAYGO) cut, and preventing any additional PAYGO cuts through 2022.

My latest for the AMA. The whole shebang.

Doctor participation in ACOs, medical homes grows amid pandemic

/ Kevin B. O'Reilly

Physician participation in accountable care organizations (ACO) and medical homes continues to grow steadily amid the COVID-19 pandemic, according to the results of an AMA survey of about 3,500 physicians.

Nearly one-third of doctors worked in practices participating in medical homes in 2020, up from 23.7% in 2014. On the ACO front, 42.7% of physicians were in practices that participated in a commercial ACO in 2020, up from 31.7% in 2016. Meanwhile, 29.5% of physicians were in practices took part in a Medicaid ACO, up from 20.9% in 2016.

And the share of physicians in practices involved in Medicare ACOs has risen from 28.6% in 2014 to 36.7% in 2020, though it dipped from a high of 38.2% in 2018.

The findings are included in the AMA Policy Research Perspectives report, “Payment and Delivery in 2020: Fee-for-Service Revenue Remains Stable While Participation Shifts in Accountable Care Organizations During the Pandemic.”

My latest for the AMA. The whole shebang.