A temporary reprieve for scheduled Medicare reimbursement reductions, slated to go into effect January 2021, was a relief for surgeons already reeling from the impact of COVID-19. Under the proposed Centers for Medicare & Medicaid Services (CMS) changes, physicians would have seen streamlined processes and higher reimbursement for evaluation/management visits. However, because CMS is statutorily obligated to maintain budget neutrality, offsetting cuts would reduce other physician reimbursements, including surgical.

The Surgical Care Coalition (SCC), which represents more than 150,000 surgeons in the U.S., spoke out against the cuts after estimating that reimbursement for surgical care could be cut by up to 9% depending on the specialty. The conversion factor, the starting point  for calculating Medicare payment, would also be cut 11% — the lowest rate in 25 years.

The SCC, a network of 12 surgical professional associations, has met informally since the 1980s to promote public policy solutions to solve the biggest challenges in healthcare. The group, which includes the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), formalized in 2020 to advocate against the CMS changes.

The group argued the proposed changes could affect access to care at a time when patients are already putting off routine medical visits due to the COVID-19 pandemic. In fact, according to a Washington Post analysis of smartphone location data, upwards of 94 million Americans delayed medical care between March and mid-May of 2020. That is both detrimental to patients as well as a major disruption to existing revenue streams in healthcare.

To underscore the existing financial distress surgeons already face due to COVID-19 even without the CMS changes, the SCC commissioned a survey of more than 5,000 surgeons. Among neurosurgeons the survey found that:

    • 74% expressed concerned about their practice’s finances
    • 54% are concerned that they will have to shut down their practice or limit care choices
    • 38% have cut their own salary
    • 24% have taken on debt
    • 86% are worried about cutting employee salaries in order to stay open
    • 76% said they may have to lay off employees in the face of declining revenues

U.S. Senator Cindy Hyde-Smith (R-Miss.) was among legislators who joined to introduce legislation to temporarily halt the proposed changes. “If our heroes this year are people who wear scrubs, then it is unconscionable to hit them with Medicare cuts as a New Year’s gift,” Hyde-Smith said in December. “This legislation needs to be passed before the holidays to provide relief to the very healthcare professionals who bear the burden of fighting this pandemic.”

On December 21, 2020, Congress passed the Consolidated Appropriations Act, 2021 delaying costly coding changes for 3 years and increasing Medicare payment codes by 3.75% for 2021. While the CMS changes are temporarily halted, there’s concern that the cuts could eventually take, affecting patient access to timely surgical care and impacting patient quality of life.

“Congressional leaders recognized it is irresponsible to cut health care in the middle of a pandemic,” said David Hoyt, MD, FACS, executive director of the American College of Surgeons. “COVID-19 has pushed our health care system to the brink, and physicians fighting on the front lines will not have this misguided policy hanging over their heads. There is still work to do to ensure patients have timely access to surgical care in 2022 and beyond, but this is a significant step in the right direction.”

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