Surgeons brace for cutbacks that could impact access to care

Medicare and Medicaid cutbacks could impact care

CHARLOTTE, N.C. (WBTV) - Surgeons in our area are bracing for cutbacks in payment from the federal government, they say could impact the care you receive.

This comes as the federal Centers for Medicare and Medicaid prepare to implement a massive cut in reimbursement rates nationwide.

Surgeons say due to the global pandemic they are working more hours than ever before, but the proposed Medicare Physician Fee Schedule would actually reduce compensation paid to surgeons. Many surgeons say that would reduce access to surgical care, further stressing an already fragile healthcare system in a pandemic.

“Surgeons won’t be able to keep their lights on,” said surgeon Dr. Shamly Dhiman.

Dr. Dhiman is talking about the impact a change to her reimbursement rates from the federal government will have.

The change is expected to take effect on January 1 as the Centers for Medicare and Medicaid Services looks to offset additional money they’re paying elsewhere.

“If you get a Medicare patient and they’re having decreased reimbursements, we won’t be able to see them," Dr. Dhiman said.

In fact, a recent survey by the Surgical Care Coalition found that doctors will have to make tough choices on patient intake and staffing.

One-third of doctors say they may reduce patient intake, and the vast majority say they will have to reduce time spent with patients or hire fewer nurses.

“With this COVID pandemic, we have seen, unfortunately, a lot of private practices in surgery, crumble and cut down their staff and have hiring freezes and have loss of jobs," Dr. Dhiman said.

The new plan cuts payments for surgical specialties, including 9 percent for cardiac surgery, 8 percent for thoracic surgery and 7 percent for vascular, neurosurgery and ophthalmology.

And if surgeons aren’t able to see Medicare patients, they won’t have access to care.

“And if we don’t take care of them, who’s going to take care of them? We’re not able to take care of our community members, if we can’t keep our lights on and we can’t continue to run a business," Dr. Dhiman said.

Congressman Dr. Larry Bucshon has introduced legislation to stop the cuts to Medicare payments for surgical specialties.

“What this does is it makes the payments unchanged for certain specialties, but it allows the payment increases that are proposed to go through for other physicians,” said Bucshon.

A spokesperson for the Centers for Medicare and Medicaid Services issued a statement saying in part:

“These paperwork requirements have not updated in over 20 years and with these changes going into effect this January, clinicians across all specialties that have patient visits will save 2.3 million hours per year in burden reduction.”

You can read the full statement here:

"Last year, the Trump Administration finalized historic changes to increase payment rates for common office/outpatient evaluation and management (E/M) visits beginning in 2021. The higher payment for E/M visits takes into account the changes in the practice of medicine, recognizing that additional resources are required of clinicians to spend time to take care of the Medicare patients. . We note that the increase in payment for the office/outpatient E/M codes, as with any changes in payment for specific services, were implemented in accordance with statutorily mandated budget neutrality requirements for the Physician Fee Schedule (PFS). The increase in payment for E/M visits helps to ensure that CMS is appropriately recognizing and valuing the kind of care where clinicians need to spend more face-to-face time with patients. In addition to the changes in payment, CMS is adopting simplified coding and billing requirements for these E/M visits that also go into effect January 1, 2021. These paperwork requirements have not been updated in over 20 years and with these changes going into effect this January, clinicians across all specialties that have patient visits will save 2.3 million hours per year in burden reduction.

"At this time, CMS is not making changes to the values of global surgery procedures to reflect the changes finalized for the E/M visits, but CMS is continuing to collect and analyze administrative claims and other data submitted by physicians and practitioners for the post-operative E/M visits that they furnish. CMS will continue to assess and develop an approach to revaluing global surgery procedures, including associated post-operative E/M visits to ensure the accuracy of payments under the Medicare Physician Fee Schedule as outlined in the Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 found here.

"As described in last year’s Calendar Year 2020 Physician Fee Schedule (PFS) final rule, CMS is required to use information collected as appropriate, along with other available data, to improve the accuracy of valuation of surgical services under the PFS. As a result, CMS has been collecting information on the number and level of post-operative visits that clinicians furnish during the global period, and intends to use this information to improve the valuation of the global surgical packages in future rulemaking.

“Prior to analyzing and incorporating the new data through rulemaking, CMS believes it is important to avoid contributing further to the potential misevaluation of global surgical procedures. Adding revised E/M work relative value updates to values for global codes could result in a disruption to the resource cost relationships that exist between services that are paid under the PFS. Any adjustments to implement an update to the global values could cause payments for other services to shift in ways that should be analyzed prior to making such adjustments.”

Surgeons like Dr. Dhiman stress that as the COVID-19 Death toll passes a quarter of a million people, now is not the time to have fewer surgeons treating Medicare patients, who in many cases, are requiring more specialized care.

“I think Congress is listening,” said Dhiman. “There have been a lot of people who are understanding this a little bit more because surgeons are being more vocal about it.”

Surgeons across the country are hoping that Congress steps in quickly to explore alternative options.

If no changes are made, the proposed Physician Fee Schedule will go into effect on January 1.

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