Primary care physicians are pleased they will be rewarded for the time and energy spent on evaluating and managing their patients, especially those with chronic conditions, per the 2021 Medicare Physician Fee Schedule (PFS), which became effective Jan. 1. But doctors who bill more surgical and procedural services and fewer E/M services have less to smile about.
The Centers for Medicare & Medicaid Services says the new fee schedule reflects the agency’s investment in primary care and chronic disease management and will cut some of the red tape traditionally associated with reimbursement. The rule also addresses telehealth and remote patient monitoring, and nails down new responsibilities for non-physician practitioners.
Under the schedule, some physician specialties will likely see a rise in Medicare reimbursement, including endocrinology, rheumatology, family practice and hematology/oncology. Other specialties, including anesthesia, emergency and surgery, won’t.
“The payment improvements will go a long way to helping physician practices over the next year as we continue to deal with COVID-19, and in the future,” said Jacqueline W. Fincher, M.D., MACP, president of the American College of Physicians, in a statement issued on Dec. 2, one day after CMS released the final schedule. “We need to ensure that practices across the country are able to continue to operate and provide frontline care in their communities.”
On the other hand, the American College of Surgeons said the new fee schedule “will harm patients and further destabilize a healthcare system already under severe strain from the COVID-19 pandemic.” The organization said that a survey it conducted in September showed that proposed payment cuts would harm patients by forcing doctors to make extremely difficult decisions, such as reducing Medicare patient intake, laying off nurses and
administrative staff, and delaying investment in technology.
Since 1992, Medicare has paid for the services of physicians and other billing professionals under the Physician Fee Schedule. Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.
To account for the increase in RVUs for E/M services and still maintain compliance with a budget neutrality adjustment, CMS decreased the 2021 conversion factor to $34.89, down $1.20 from the previous year’s conversion factor of $36.09.
Projected winners, losers from 2021 Medicare Physician Fee Schedule
Specialty Impact
Winners
Endocrinology 14%
Rheumatology 13%
Hematology/oncology 12%
Family medicine 12%
Nephrology 11%
Clinical social worker 9%
Physician assistant 9%
Nurse practitioner 9%
General practice 8%
Psychiatry 8%
Interventional pain mgmt. 8%
Clinical psychologist 8%
Allergy/immunology 8%
Urology 8%
Losers
Anesthesiology -1%
Vascular surgery -1%
Cardiac surgery -2%
Chiropractor -2%
Interventional radiology -2%
Physical/occupational therapy -2%
Pathology -2%
Radiology -3%
Nurse anesthetist/assistant -3%
Somewhere in between
Obstetrics/gynecology 7%
Pediatrics 7%
Internal medicine 6%
Geriatrics 6%
Otolaryngology 6%
Podiatry 6%
Dermatology 5%
Cardiology 4%
Pulmonary disease 4%
Gastroenterology 2%
General surgery 0%
Source: American Medical Association. (For a complete list of specialties, see: American Medical Association)