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WASHINGTON -- Physicians will see a 10% cut in the "conversion factor" used to determine their fee-for-service Medicare payment under the released late Tuesday by the Centers for Medicare & Medicaid Services (CMS).

The conversion factor is the multiplier that Medicare applies to relative value units (RVUs) to calculate reimbursement for a particular service or procedure under Medicare's fee-for-service system. Due to budget neutrality changes required by law, the 2021 conversion factor will be $32.41, a decrease of $3.68 -- or 10.2% -- from the 2020 conversion factor of $36.09, CMS said in a .

Decrease "Deeply Troubling" to Some

The rule quickly drew complaints from some physician groups. "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," Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association, which represents physician offices, . "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."

The American College of Emergency Physicians (ACEP) by the payment cut. "Emergency physicians and other health care providers battling on the frontlines of the ongoing pandemic are already under unprecedented financial strain as they continue to bear the brunt of COVID-19," ACEP President Mark Rosenberg, DO, said in a statement. "These cuts would have a devastating impact for the future of emergency medicine and could seriously impede patients' access to emergency care when they need it most."

ACEP noted that the cut will result in a 6% payment decrease for emergency treatment providers. When the cuts were first proposed over the summer, "ACEP provided specific policy recommendations to the agency that would completely eliminate or at least mitigate the reduction -- but unfortunately none of them were ultimately incorporated," the statement said. "Instead, CMS chose to finalize a cut that will reverberate beyond just Medicare to other payors including private insurance, which often structure their payments to emergency physicians and other providers based on these Medicare rates. This will result in significant reimbursement reductions as well as widespread uncertainty and disruption across the system."

CMS's Positive Spin

In a , CMS put a positive face on the final rule, pointing out that the agency is "prioritizing CMS' investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions." CMS accomplished this in part by increasing payments for evaluation and management, or E/M, codes for chronic care visits.

Indeed, specialties that care for patients with chronic conditions fare the best under the fee schedule -- as seen on page 1660 of the -- with endocrinologists receiving an estimated 16% payment increase, followed by rheumatologists with a 15% pay bump, and hematologists/oncologists with a 14% increase. Family physicians received a 13% increase, while internists' reimbursement increased by 4%. The that it "commends CMS for recognizing the importance of cognitive care specialties, including rheumatology, by finalizing E/M values that better reflect the work and medical decision making of our members."

On the other end of the spectrum, chiropractors, nurse anesthetists/anesthesia assistants, and radiologists all saw their reimbursement drop by 10%, while pathologists and physical and occupational therapists got a 9% cut. Anesthesiologists, cardiac surgeons, interventional radiologists, nuclear medicine physicians, and thoracic surgeons all received an 8% pay cut. The Surgical Care Coalition, which includes 12 different surgical professional associations, that the new fee schedule "will harm patients and further destabilize a healthcare system already under severe strain from the pandemic. Congress must work swiftly to reverse these devastating cuts to protect patient access to care before it recesses for the year."

Possible Congressional Action

Coalition members are among 60 medical organizations which signed a , the , which is co-sponsored by two physician members of the House, Ami Bera, MD (D-Calif.), and Larry Bucshon, MD (R-Ind.). The act, which has 54 co-sponsors, would block the payment cuts.

"This critical legislation ... provides a necessary reprieve for a broad array of physicians and non-physician health care providers facing substantial payment reductions in the coming months, while also allowing payment increases to go forward for those who provide E/M services to Medicare beneficiaries in a stand-alone office visit or outpatient setting," the statement says. "If Congress fails to mitigate these cuts, decreases in Medicare payments will further exacerbate the problems occurring across the country with practices and institution-based providers furloughing or cutting staff and an increasing number closing their doors in response to the COVID-19 pandemic."

Susan Bailey, MD, president of the American Medical Association (AMA), which represents a variety of physician specialties -- including both winners and losers in the final rule -- in her statement. She praised the rule's E/M payment increases and its other steps to simplify physician paperwork, calling them "foundational improvements," but then added, "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. 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 ... 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," Bailey continued. "For this reason, the AMA strongly urges Congress to prevent or postpone the payment reductions resulting from Medicare's budget neutrality requirement. Physicians are already experiencing substantial economic hardships due to COVID-19, so these payment cuts could not come at a worse time."

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