What is your New Year's resolution? If you're like me, you end up with a few resolutions; some “stick” and others do not. I recommend that you add getting involved in advocacy, ideally with ACP, to your list. As I write this, I can point to a number of advocacy wins ACP has achieved over the past year, and I am hopeful that by the time you read this, there will be more. However, physicians and their practices still face ongoing challenges, and physicians themselves are needed to fight for these changes.
In 2021, ACP saw some real achievements. We have tirelessly fought for universal health care coverage for decades, and more recently our New Vision for the U.S. Health Care System has served as our guiding light. In June 2021, the Supreme Court made a monumental decision to keep the Affordable Care Act (ACA) in place, thus ensuring that the coverage, benefits, and protections this law offers to millions of Americans will likewise stay in place. ACP had joined with several other medical organizations on an amicus brief to the court that detailed the great harm that would have come from overturning this law.
Additionally, 2021 brought the passage of the American Rescue Plan Act, which served to increase funding for and coverage of vaccines; improve and extend health care coverage, including for Medicaid recipients; provide subsidies and tax credits to make coverage more affordable; and invest in health care services for veterans. The Infrastructure Investment and Jobs Act of 2021 advanced other ACP priorities, including significant investment in broadband, as well as provisions to address climate change. More wins are expected to be achieved with the passage of the Build Back Better Act, an expansive reconciliations package that at press time was still being debated in Congress.
Last year also saw the implementation of significantly revised evaluation and management (E/M) codes within Medicare, leading to increased payment and reduced documentation for many. These changes were hard fought with ACP at the forefront—but like many positive changes, they come with some new challenges that must now be addressed. Private payers and health care systems are implementing these changes inconsistently and sometimes in a manner that does not allow the frontline physician to see the benefit. Additionally, due to the requirement for budget neutrality within the Medicare Physician Fee Schedule, these E/M code revisions, along with other changes, led to a decrease in the conversion factor in 2021. This meant that all physician services would be subject to a reduction—and thus, the full increased value of the E/M services would not have been felt. Congress stepped in and addressed this issue last year by passing the Consolidated Appropriations Act (CAA) of 2021. This law included a provision specifying a temporary 3.75% increase to all services, thus mitigating a substantial portion of the expected cuts.
We were again facing those cuts for 2022. The 2022 Physician Fee Schedule was finalized with a reduced conversion factor from 2021, so this impending threat of a 3.75% cut was again on the table. Like last year, Representatives Ami Bera, MD, FACP (D-CA-7) and Larry Bucshon, MD (R-IN-8) sponsored critical legislation that would provide a one-year patch—the Supporting Medicare Providers Act of 2021. ACP joined a letter sent by these two members of Congress to the leadership of the U.S. House of Representatives calling for this fix in October and have also expressed our strong support for their bill, which was released on Nov. 19, 2021. However, at the time of this writing, Congress is still working to finalize the Build Back Better Act, as well as to advance the 2022 appropriations bills and address the debt ceiling crisis that is looming. It seemed as if nothing else would get done until these items were complete.
The potential Medicare physician payment cuts run even deeper than this and demonstrate why it is so important that Congress hear from ACP members in a consistent manner about their own experiences, particularly how congressional action (or inaction) impacts their patients. Another key component of the Medicare payment cuts is the 2% budget sequester, which was initially established by the 2011 Budget Control Act (BCA) as a means of deficit reduction when Congress is unable to enact other budget reforms. This sequestration was then extended to 2030 in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, although it was temporarily suspended from May 2020 to December 2021. As noted earlier, the recently enacted infrastructure bill includes a number of priorities for ACP; however, on the downside, it also includes the BCA 2% sequester as a “pay for” to cover some of its new spending. ACP has advocated against the sequester since it was enacted—and has achieved some short-term suspensions of it—and yet this fight must go on.
Another type of sequestration also threatens physicians in the form of PAYGO, which stands for “Pay As You Go.” This arose from the Budget Enforcement Act in 1990 and then was reinstated via the Statutory Pay-As-You-Go Act of 2010. According to this law, any legislation where the revenue and/or mandatory spending projects an increase in the deficit over a five- and/or 10-year period must result in a mandatory sequester of spending. The recently enacted American Rescue Plan Act, which does include a number of top policy priorities for ACP, triggered the PAYGO rules, thus leading to an anticipated 4% PAYGO sequester. This sequester impacts all health care entities, including hospitals.
All in all, physicians could have faced an up to 10% Medicare payment cut. At nearly the final hour, Congress passed S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act, which provides a significant amount of temporary relief to the Medicare payment and sequestration cuts—thanks to the engagement of many of you in our grassroots outreach campaign. However, to effectively achieve change, a long game is needed. A key component of that long game is you.
Congress needs to hear from physicians directly, as good policy should not come at the expense of those providing necessary care to their patients. It is important for Congress to understand how this pandemic has shown the value of internal medicine physicians who remain on the frontlines of diagnosing and treating patients with COVID-19, as well as continuing to care for patients with chronic illnesses such as cancer, heart disease, and diabetes, via both in-office visits and telemedicine. They need to hear your stories. Therefore, I implore you to make advocacy, whether at the national or local level, one of your top New Year's resolutions.