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Rush, Bilirakis Lead 73 Members in Letter Opposing Medicare Pay Cuts to Critical Services

September 14, 2021

CMS proposed rule would cut reimbursement for specialty providers treating cancer, kidney failure, other diseases by up to 20 percent; disproportionately harm Black and Latino Medicare patients

WASHINGTON — This week, U.S. Representatives Bobby L. Rush (D-Ill.) and Gus Bilirakis (R-Fla.) led 73 of their House colleagues in a letter to the Centers for Medicare & Medicaid Services (CMS) urging CMS not to finalize a portion of the proposed 2022 Physician Fee Schedule (PFS) rule that would cut Medicare reimbursement rates by up to 20 percent for specialists providing treatment for cancer, kidney failure, artery disease, and other diseases.

Because the PFS is required to be budget-neutral, the proposed rule — which updates data related to clinical labor — would necessitate massive pay cuts to specialty providers, many of whom provide treatment for diseases that disproportionately affect Black and Latino patients. The Members warned that the clinical labor portion of the proposed rule undermines efforts to achieve health equity and will force specialty providers to close, leading to even worse health impacts for vulnerable groups.

“Because of aforementioned PFS ‘budget-neutrality,’ the incorporation of new clinical labor data actually results in massive cuts of up to 20 percent to critical services in the PFS. These impacts also will have profoundly negative effects on health equity. While President Biden’s FY 2022 Budget contained many worthy provisions aimed at addressing health inequity through the elimination of disparities in health care, the 2022 PFS Proposed Rule actually threatens to undermine these initiatives,” the Members wrote.“These ongoing cuts to specialties under the PFS also are weakening our healthcare system’s ability to deal with the ongoing COVID-19 pandemic.”

Concluding, the Members urged CMS not to finalize the clinical labor policy and to “work with Congress on fundamental reform to the PFS.”

Specific services that would be subject to pay cuts under the proposed rule include treatments for venous ulcers (23% cut to endovenous radiofrequency ablation), kidney failure (18% cut to dialysis vascular access), cancer (15% cut to radiation oncology), peripheral artery disease (22% cut to revascularization procedures), and uterine fibroids (21% cut to uterine fibroid embolization). Members pointed out that all of these conditions disproportionately affect Black patients.

These cuts to specialty service providers would come on top of additional looming cuts for specialty providers to offset last year’s scheduled fee increase for Medicare office-based evaluation and management (E/M). Last year, Rush ledmultipleletters to House leadership and to CMS emphasizing the importance of preventing these cuts in order to protect patients' access to care during the COVID-19 pandemic. In part due to Rep. Rush’s advocacy, those cuts were delayed and will begin to be phased in starting January 2022.

The full text of the Rush-Bilirakis letter can be found HERE.

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Issues:Health Care