Congress recalibrates Medicare Physician Fee Schedule after lobbying

January 05, 2021


After a lobbying frenzy that pitted primary care providers against specialty physicians, Congress decided to recalibrate the Medicare Physician Fee Schedule in its latest stimulus and government funding bill.

CMS decided to give primary care providers a pay boost in the 2021 physician fee schedule through changes to pay for evaluation and management services and creating an additional add-on code for serving patients with multiple chronic conditions. Because of budget neutrality requirements, the pay increases to primary care had to be offset with cuts to other specialties.

“Every year there is a zero-sum game. With a new code, there have to be requisite cuts to offset payment of new code. That is where all of the heartburn comes from,” said Stephanie Quinn, senior vice president of advocacy, practice advancement and policy at the American Academy of Family Physicians.

The zero-sum environment sparked a lobbying offensive by some specialty providers who worked to convince lawmakers that they shouldn’t face significant pay cuts during a pandemic. Twelve surgeons’ groups joined forces to argue for relief from the cuts and other specialties including radiologists, pathologists and physical therapists were also affected. The American Medical Association endorsed a bill sponsored by Reps. Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.) that would have provided a temporary additional payment for providers who saw pay cuts.

But primary care providers had concerns that the Bera-Bucshon legislation would distort their funding for 2022, so they opposed the bill and called for a waiver for budget neutrality rules instead.

Lawmakers ultimately decided to give providers an across-the-board 3.75% pay increase for the 2021 calendar year, which cost $3 billion.

“COVID-19 has pushed our healthcare system to the brink, and physicians fighting on the front lines will not have this misguided policy hanging over their heads,” said Dr. John Wilson, president of the American Association of Neurological Surgeons.

Congress also chose to delay the new add-on code that would have benefited primary care providers for three years, which was a loss for primary care.

“We were disappointed in the delay, but that doesn’t take away that with the increases, this is the biggest investment in primary care in the last 30 years,” Quinn said.

With the new changes, the Surgical Care Coalition said most specialties are no longer facing cuts.