This summer, the Centers for Medicare and Medicaid Services (CMS) published their annual Medicare Physician Fee Schedule (MPFS) proposed rule. The proposed changes would have imposed severe cuts on Medicare pay for intervention radiologists: office-based physicians were expected to receive a 6% cut and those performing lower-extremity procedures would experience 14–20% cuts. For IRs in office-based lab settings, the proposed cuts would be devastating, especially as private insurers often follow the rates set by CMS.
SIR launched an aggressive advocacy campaign in opposition of the cuts, meeting with the deputy director of CMS, the director of the Center for Medicare at CMS and the Offices of Budget and Management and Science and Technology Policy at the White House. Along with the Cardiovascular Coalition, the American College of Radiology Medicare Coalition, the American Medical Association’s Medicare Coalition and the Clinical Labor Coalition, SIR succeeded in negotiating the cuts down to an aggregate 9% for some members.
After CMS published the final MPFS rule for CY2022, SIR asked Congress to extend the 3.75% conversion factor pay increase throughout 2022. As part of this effort, 1,115 members sent more than 4,000 letters to every congressional office except Alaska, and 20 IRs met with 70 congressional offices to explain the impact of the Medicare cuts on IR.
The campaign was successful: Just before the holidays, Congress passed a bill that included the Medicare Provider Relief package to:
Extend the conversion factor increase for another year, but at 3% rather than 3.75%
Waive the 4% statutory Pay-as-you-go (PAYGO) cut through the end of 2022
Minimize the impacts of sequestration by waiving sequestration cuts through March 2022, phasing in a 1% cut for April–June
Clinical labor wage update
Despite the victory, the work isn’t over. This year, CMS published a proposed clinical labor wage update for the first time in 20 years. While an update is needed, adjusting clinical labor wages during a global pandemic will deeply impact patients and providers. Any provider doing vascular surgery or office-based lower extremity venous procedures will be among those most impacted by the wage update. This is a large group of people that includes not only IRs, but vascular surgeons and radiation oncologists as well. In addition, anyone who utilizes a lot of technology in their procedures will be impacted, as the wage updates can relate to the amount of technology needed and the skilled technicians required to use the technology.
As a result, office-based and private-practice providers will be hit hardest. Large medical centers absorb the costs of the necessary technology and staff, but physicians at OBLs and some community centers will absorb the costs themselves.
While the clinical labor wage update will impact physicians, CMS has agreed to phase it in over a 4-year period. However, efforts are already underway to block the update. SIR is actively supporting H.R. 6048, introduced by Reps. Bobby L. Rush, D-Ill., and Gus Bilirakis, R-Fla. If enacted, the bill will direct the Health and Human Services secretary to direct CMS to halt the update. H.R. 6048 is expected to be included in a mini omnibus bill that is anticipated to pass in the House in February.
Once again, SIR ended the year with successful advocacy efforts, but fighting against pay cuts up until the end of the year is not a sustainable model. Even with negotiations, physicians still feel the impact. That is why SIR is joining a medicine-wide request for meaningful reform of the way we reimburse our physicians. The society will keep you updated on such developments in SIR communication and publication channels.
