Proposed Physician Fee Schedule calls for more than 10% decrease

August 4, 2020

CMS is proposing a decrease of $3.83 from last year in the conversion factor used to calculate doctor reimbursement

CMS has released the proposed Medicare annual payment rule for 2021, including the Physician Fee Schedule and updates to the Merit-based Incentive Payment System.

This year’s conversion factor contains a significant budget neutrality adjustment that is required by law. The proposed 2021 PFS conversion factor is $32.26, a decrease of $3.83 from last year’s schedule, a decrease of more than 10%.

In addition, CMS is soliciting comments on making a number of telehealth services that were added during the COVID-19 public health emergency permanent.

CMS is also proposing to allow nurse practitioners, clinical nurse specialists, physician assistants and certified nurse midwives to supervise the performance of diagnostic tests in addition to physicians. This flexibility was granted during the pandemic, but the agency is now looking at making it permanent.

The policy allowing teaching physicians to supervise residents remotely using telehealth, which was instituted during COVID, is also being considered for permanent implementation.

MIPS changes

CMS is granting hardship exemptions on a case-by-case basis due to the pandemic. A clinician or group can request an exemption from all four performance categories in 2020. An exemption will negate any payment adjustment in 2022—meaning that they will not be eligible for a bonus or potentially face a penalty based on their MIPS performance in 2020.

CMS is proposing to reduce the quality category weight from 45 to 40% and increase the cost category from 15 to 20%. By law, the quality and cost categories must each be weighted at 30% starting in 2022.

These changes, if approved, would yield the following scoring weights:

  • Quality: 40%
  • Cost: 20%
  • Promoting Interoperability (EHR): 25%
  • Improvement Activities: 15%

CMS is also proposing to lower the performance threshold needed to avoid a penalty in 2021 to 50 points. Last year, the plan was to set the performance threshold at 60 points for this year, but CMS is now proposing a lower threshold. The maximum payment adjustment is still 9%.

Medical Economics will have more coverage as the story develops.