'Slap in the face': New Medicare rule to cut emergency doctors' pay amid COVID-19 pandemic
LOS ANGELES - The United States is in the middle of a deadly wave of the coronavirus pandemic, leaving health care workers overwhelmed, exhausted and stretched by shortages of staff, hospital beds and other resources needed to deal with the influx of patients sickened by COVID-19.
Many already-beleaguered physicians are also facing a potential pay cut as a new rule passed by Congress, set to go into effect Jan. 1, will lower the reimbursement rates that clinicians receive for treating patients covered by Medicare.
Some doctors practicing general surgery, emergency medicine, anesthesiology, and critical care medicine — some of the key front-line health care professionals leading the U.S. through the pandemic — will receive what amounts to a 5% to 8% pay cut in 2021 under the new rule.
Medical personnel move patients in a bustling hallway in the emergency department during the coronavirus (COVID-19) pandemic at Mount Sinai South Nassau Hospital in Oceanside, New York on April 13, 2020.
"We come to work every day and we work long hours and we put our lives on the line and took risks on a daily basis and it’s a slap in the face to say here’s how we’re gonna reward you — we’re going to be paying you less," Dr. Lisa Moreno, an emergency medicine physician and the president of the American Academy of Emergency Medicine (AAEM), said.
Moreno said the CY 2021 Medicare Physician Fee Schedule Final Rule, which was proposed by the Centers for Medicare and Medicaid Services (CMS) and placed on display at the Federal Register on Dec. 2, 2020, will reward physicians who are engaged in more of the cognitive aspects of medicine and decrease the payment to physicians who are more involved in procedural medicine.
On Dec. 1, the American College of Emergency Physicians (ACEP) announced that they were disappointed and dismayed by the final 2021 rule, suggesting that it would have a devastating effect on the nation’s health care system and place a further strain on its health care professionals.
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"Emergency physicians and other health care providers battling on the frontlines of the ongoing pandemic are already under unprecedented financial strain as they continue to bear the brunt of COVID-19," said Dr. Mark Rosenberg, president of ACEP. "These cuts would have a devastating impact for the future of emergency medicine and could seriously impede patients’ access to emergency care when they need it most."
After CMS first proposed the steep cut over the summer, ACEP said that they provided other policy recommendations to the agency that would completely eliminate, or at least mitigate, the reduction.
"Instead, CMS chose to finalize a cut that will reverberate beyond just Medicare to other payors including private insurance, which often structure their payments to emergency physicians and other providers based on these Medicare rates. This will result in significant reimbursement reductions as well as widespread uncertainty and disruption across the system," ACEP wrote in a press release on Dec. 1.
CMS told FOX TV Stations that the payment changes were informed by recommendations from the American Medical Association.
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"These changes were enacted last year, when CMS took steps to increase payment rates for evaluation and management codes, often known as common office visits, reflecting the most significant revision in payment to the E/M codes since they were instituted," CMS said in a statement to FOX TV Stations.
"The increase in payment for E/M codes, as with any changes in payment for specific services, must be implemented in accordance with statutorily mandated budget neutrality requirements. As we increase payment in certain places to drive value in healthcare, especially for chronic care management and preventive care, we also must by law decrease payment for other services to maintain budget neutrality," the statement read.
But Moreno pushed back on that assertion, saying CMS was mischaracterizing the sort of care that emergency physicians often render to patients with chronic conditions.
"Where do you get the information that says that emergency surgeons and physicians and anesthesiologists are not managing the chronically ill?" Moreno asked. "As an emergency physician, I can tell you that probably 50% of the people that I see every day are coming in because they need me to manage their chronic illness."
CMS said the new rule will go into effect on Jan. 1 "as long-planned" and will "bring Medicare payment in line with the value that common office visits render to the patient and broader healthcare system."
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"We value the contributions of all providers caring for patients on the front-lines of this historic pandemic, but this action is designed to address fundamental problems in Medicare reimbursement that long pre-date the current public health emergency. It is also important to note that physicians that see a higher proportion of patients’ visits will see increases in payments compared to physicians that do fewer visits or more procedures," CMS wrote.
ACEP, along with other health care organizations, believe the only way to prevent the cuts from taking place is for Congress to pass legislation holding physicians harmless from Medicare cuts during the pandemic.
The bill — introduced by Rep. Ami Bera, M.D., D-Calif., and Rep. Larry Bucshon, M.D., R-Ind. — would "temporarily maintain for the next two years physicians’ reimbursement in Medicare at 2020 levels if they were otherwise scheduled to receive a payment cut," ACEP said.
"Emergency physicians have courageously faced a global pandemic that has shaken our health care system to its core, unwavering in their commitment to their patients despite potentially deadly exposure to the disease for themselves and their families," said Rosenberg. "Congress must act now in order for them to continue playing this vital role in our communities."
More than 800,000 health care workers have lost their jobs in the U.S. since the pandemic began, according to a jobs report released in July by the U.S. Bureau of Labor Statistics.
"We are seeing a lot of burnout," Moreno said. "The physician suicide rate is twice that of the rest of the country. We’re seeing individuals leaving the field."
The U.S. continues to experience a record number of daily COVID-19 cases and hospitalizations, along with the heartbreaking reality of more than 310,000 U.S. deaths from the deadly disease.
"To think, now we can just absorb in our country 3,000 deaths a day as though it were just business as usual. It just represents a moral failing," said Jennifer Nuzzo, a public health researcher at Johns Hopkins to the Associated Press.