CMS issues final 2021 Physician Fee Schedule

Conversion factor drops by 10%, but some practices will benefit from increased E/M coding levels.

CMS issued the final rule for the 2021 Physician Fee Schedule and doctors will see a conversion factor of $32.41, a decrease of $3.68 from the 2020 PFS conversion factor of $36.09.

According to CMS, the lower conversion factor is a result of the budget neutrality adjustment, as required by law, to account for changes in RVUs, including significant increases for E/M visit codes.

The decreased conversion factor is concerning to many physician advocacy groups.

“While MGMA is appreciative of streamlined documentation policies and payment increases to physicians that primarily deliver office/outpatient E/M services, the 10% decrease to the conversion factor and resulting reimbursement cuts to many specialties is deeply troubling during a time when COVID-19 cases are skyrocketing and practices are scrambling to stay financially viable,” said Anders Gilberg, senior vice president, government affairs, Medical Group Management Association, in a statement. “We are disappointed that CMS decided to not provide the stability that physician practices require to meet patient needs during this unprecedented public health emergency.”

While the American Medical Association applauded the changes to E/M coding, which it says will make documenting office visits simpler and more flexible, it also had concerns about the decreased conversion factor.

“Unfortunately, the newly adopted office visit payment rates, and other payment increases finalized in today’s rule, are required by statute to be offset by payment reductions to other medical services covered by Medicare,” said Susan R. Bailey, MD, president of the AMA. “This will result in a shocking reduction of 10.2% to Medicare payment rates in the midst of the worsening COVID-19 pandemic while physicians are continuing to care for record numbers of patients diagnosed with COVID-19 and trying to keep the lights on in their practices. These cuts will hurt all Medicare patients, particularly those seeking care for COVID-19 critical care and hospital visits that will be reduced dramatically.”

The AMA is lobbying Congress to prevent or postpone the payment reductions at this time.

In addition to the PFS, CMS added 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the public health emergency. It also made sweeping changes to how quality is assessed in the Medicare Shared Savings Program. When this change was proposed, many health care organizations objected, citing the ongoing public health emergency and that late release of the final rule gives Accountable Care Organizations little time to assess and prepare for changes before the rule goes into effect.

In a statement, Clif Gaus, president and CEO of the National Association of ACOs, urged CMS and the incoming administration to reconsider many of the ACO quality changes finalized in the 2021 PFS rule and to work more closely with stakeholders to find appropriate solutions for streamlining ACO quality while maintaining quality as a core focus of the ACO program. “We also request the agency provide safeguards for ACOs that may not be able to report 2020 quality data in early 2021 given the surges in cases of COVID-19 we are currently seeing across the country,” he added.