Cuts in Medicare payments jeopardize patient access to neurointerventional care

The final 2021 Medicare Physician Fee Schedule issued this week by the Centers for Medicare and Medicaid Services will result in reimbursement cuts in the range of 10% for neurointerventional procedures, according to a detailed analysis in the Journal of NeuroInterventional Surgery, a peer-reviewed journal for the clinical field of neurointerventional surgery. 

Practitioners warn that this measure will jeopardize access to lifesaving care for individuals experiencing strokes, aneurysms and other deadly conditions.

WHAT’S THE IMPACT

The JNIS article outlines the potential impact of the new fee schedule and raises the alarm that this action by CMS could further compound current challenges to the viability of neurointerventional practices, which already have been severely impacted by the COVID-19 pandemic.

The catalyst for this potentially harmful change is Medicare’s budget-neutrality requirements, which require substantial reductions to offset payment increases approved in other areas of the healthcare system. The authors point to the fact that these impacts will almost certainly be compounded in upcoming years. They predict even more severe economic impacts as private payers follow Medicare’s lead.

While the rule originates in Medicare, private insurers often base their own rates on thoser set by CMS, and combined this represents about 80% of the patient population, which will present a challenge for some practices in withstanding that level of reimbursement reduction.

To combat this change, the Society of NeuroInterventional Surgery — an association representing neuroendovascular care professionals and the sponsor of JNIS — has joined a coalition of professional societies urging Congress to provide a legislative fix. 

The coalition contends that CMS’ approach puts practices at risk in the middle of a burdensome pandemic, and that Congress should move quickly to add stability to the system without diminishing access to diagnostic tests and procedures in the meantime.

THE LARGER TREND

The fee schedule received pushback from several groups even before it was finalized. Citing the pandemic, 10 leading healthcare organizations urged CMS in September not to move forward with changes to how accountable care organizations and other alternative payment models are assessed on quality in the Medicare Shared Savings Program and the merit-based incentive payment system. Those changes are in the physician fee schedule.

The American Telemedicine Association also weighed in in September, advocating for expanding access to more telehealth services and providers, changes to remote patient monitoring services, and telehealth in federally qualified health centers and rural health clinics.
CMS did expand telehealth in the final rule, but CMS Administrator Seema Verma warned that telehealth could go back to being a rural health benefit without congressional action.

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