American College of Surgeons Opposes New Fee Schedule

The American College of Surgeons (ACS) issued a statement in August about its opposition to the Medicare Physician Fee Schedule proposed by the Centers for Medicare & Medicaid Services (CMS) for calendar year 2021. (Read more of that statement here.)

Same-Day Surgery (SDS) asked Beth H. Sutton, MD, FACS, chair of the board of regents for ACS, and L. Scott Levin, MD, FACS, FAOA, vice chair of the board of regents for ACS, how this proposed fee schedule could affect surgery centers.

(Editor’s Note: This interview was conducted by email. The transcript has been lightly edited for length and clarity.)

SDS: What are the main problems, from a surgeon’s perspective, with the proposal?

Sutton and Levin: The Medicare Physician Fee Schedule will jeopardize patient care by cutting Medicare payments to surgeons, with some surgical specialties seeing up to a 9% cut. If implemented, patients (especially older Americans in the Medicare system) will bear the brunt of these cuts.

The rule likely will force surgeons and hospitals to take fewer Medicare patients, leading to longer wait times and reduced access to care. Medicare patients already are vulnerable, given their age, and this could lead to reduced access to care and loss of choice.

Additionally, trying to implement this policy during a pandemic is even more shortsighted. Now is not the time to make any cuts to doctors or healthcare.

SDS: Did CMS offer any explanation for why it is proposing payment cuts for all surgical specialties, and what could be the possible rationale?

Sutton and Levin: CMS is increasing payments for some doctors while cutting payments to surgeons because current Medicare rules require any changes to be budget neutral. This is why we have advocated for Congress to waive Medicare’s budget neutrality requirements for the E/M adjustments to ensure that no doctors experience a payment cut, especially during a pandemic. Additionally, we believe Congress should require CMS to apply the increased E/M adjustment to the 10- and 90-day global code values. We believe this will ensure Medicare patients have the best access to the best care when they need it and where they need it.

(Editor’s Note: CMS explained its rationale in this release, available here.)

SDS: Why is this fee schedule change particularly troublesome in light of the ongoing COVID-19 pandemic? How might it affect patients’ access to elective surgeries?

Sutton and Levin: If Congress allows these cuts to go into effect while the country continues to confront the coronavirus, older Americans will see the greatest impact, as doctors will be forced to take fewer Medicare patients.

This comes as COVID-19 has already impacted patients by the delay in non-emergent surgeries like removing tumors, repairing hernias, and placing heart stents.

While the pause on non-emergent surgery was necessary to protect patients and doctors on the frontlines, as well as to conserve valuable supplies, it has caused a ripple effect across the healthcare system.

Prior to COVID-19, the median hospital margin was 3.5%. Even in the most optimistic scenario, assuming a decrease in COVID-19 cases, median margins could be -1% by the fourth quarter of this year. Under a different scenario, assuming periodic COVID-19 surges similar to now, margins could be at -11%.

(Editor’s Note: Learn much more about this detailed report by Kaufman, Hall & Associates that was released over the summer here.)

SDS: How might this threaten the economic health of surgery centers?

Sutton and Levin: Many surgeons who use same-day surgery centers will be impacted by these cuts. In a survey earlier this year, one in three private practice surgeons shared they may have to close their practices due to the financial strain of the COVID-19 pandemic. When that is coupled with the planned cuts to Medicare, even more private surgical practices may close, which could further impact same-day surgery centers. While the healthcare system is under tremendous financial stress due to COVID-19, now is not the time to cut healthcare and create more uncertainty by disrupting patients’ timely access to surgical care.

That is why the American College of Surgeons and Surgical Care Coalition have been urging Congress to waive Medicare’s budget neutrality requirements to ensure no doctor sees their payments cut, especially during the current healthcare crisis.