Release of final Medicare payment rates raises ire of physician groups

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A number of healthcare groups are protesting final rules on Medicare 2022 payment released late on November 2 by the U.S. Centers for Medicare and Medicare Services (CMS). The rules lock in a number of payment cuts for healthcare providers.

CMS on Tuesday released final rules for its 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS), which govern how much Medicare and Medicaid pay physicians and hospitals. The final rule appears to be largely in line with proposals CMS issued earlier this year.

For example, the final rule sets the conversion factor per relative value unit (RVU) for the MPFS at $33.59 for calendar 2022, a decrease of $1.30 from the 2021 MPFS conversion factor of $34.89. CMS had proposed a conversion factor of $33.58 in its proposed rule.

CMS also finalized its proposal to start the payment penalty phase of the appropriate use criteria (AUC) program on the later of January 1, 2023, or the January 1 that follows the declared end of the public health emergency for COVID-19. The rule would apply penalties to physicians who order advanced imaging services without clinical decision support based on AUC.

Physician groups had lobbied vociferously against the proposed rates, but those protests were apparently in vain. One group, the American Society for Radiation Oncology (ASTRO), in particular objected to the fact that CMS is sticking to its previously announced timeline to launch major changes in radiation oncology reimbursement starting in January 2022.

These changes, called the Radiation Oncology Model (RO Model), would bundle radiation therapy payments rather than continue to pay on the basis of individual treatment episodes. The RO Model would radically change reimbursement for many radiation therapy practices, and ASTRO had been urging CMS to postpone implementation to give practices more time to adapt.

"The planned January 1, 2022, start date for the hundreds of radiation oncology facilities required to participate in the Radiation Oncology Model (RO Model) is extremely challenging," said Dr. Laura Dawson, chair of ASTRO's board of directors.

ASTRO said it would continue to work with CMS on ways to improve cancer care and suggested that a "legislative solution" could be necessary.

Another group, the American College of Surgeons, called on the U.S. Congress to stop the "harmful" cuts, which it said would destabilize a healthcare system already on the ropes due to the COVID-19 pandemic.

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