2021 MPFS Final Rule: See impact by specialty

2021 MPFS Final Rule: See impact by specialty

After a significant delay and much back and forth between health care provider advocates and Congress, the 2021 Medicare Physician Fee Schedule Final Rule was released Dec. 2. It finalizes several telehealth flexibilities introduced during the public health emergency while also significantly overhauling reimbursements for evaluation and management (E/M) services.

Providers will see a roughly 10% reduction in the conversion factor used to determine their fee-for-service Medicare payment in order to maintain budget neutrality as CMS significantly boosts payments for E/M services at the expense of procedure-intensive specialties.

The 2021 conversion factor is $32.41, which is a whopping decrease of $3.68 from the 2020 MPFS conversion factor of $36.09. Pathology and Independent Labs are expected to see overall reimbursement cuts of 9% and 5%, respectively, while radiology will experience a 10% cut.

There is legislation pending in Congress (HR 8702) that requests a 1-year exemption from MPFS budget neutrality requirements, however, passage is not imminent at this time. Currently, Stark is moving forward assuming these cuts will remain in place. RVU data for individual codes has not yet been published, but we will provide further analysis on rate changes once that data is made available.

In a press release announcing the rule, CMS said its intent was “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.” Specialties that care for patients with chronic conditions received the most significant gains, with endocrinologists receiving a 16% increase, followed by rheumatologists with a 15% pay bump, and hematologists/oncologists with a 14% increase. Meanwhile, Family physicians are also slated to benefit from a 13% pay raise.

Conversely, chiropractors, nurse anesthetists/anesthesia assistants, and radiologists were among the most severely affected by cuts, with each seeing their reimbursement drop by 10%. Anesthesiologists, cardiac surgeons, interventional radiologists, nuclear medicine physicians, and thoracic surgeons all also received an 8% pay cut.

Below are the estimated impact of the fee schedule changes by specialty:

(A)
Specialty
(B)
Allowed Charges (mil)
(C)
Impact of Work RVU
Changes
(D)
Impact of PE RVU
Changes
(E)
Impact of MP RVU
Changes
(F)
Combined Impact
Allergy/Immunology$2475%4%0%9%
Anesthesiology$2,020-6%-1%0%-8%
Audiologist$75-4%-2%0%-6%
Cardiac Surgery$266-5%-2%0%-8%
Cardiology$6,8711%0%0%1%
Chiropractor$765-7%-3%0%-10%
Clinical Psychologist$8320%0%0%0%
Clinical Social Worker$8570%1%0%1%
Colon And Rectal Surgery$168-4%-1%0%-5%
Critical Care$378-6%-1%0%-7%
Dermatology$3,767-1%0%0%-1%
Diagnostic Testing Facility$748-1%-2%0%-3%
Emergency Medicine$3,077-5%-1%0%-6%
Endocrinology$50810%5%1%16%
Family Practice$60208%4%0%13%
Gastroenterology$1,757-3%-1%0%-4%
General Practice$4125%2%0%7%
General Surgery$2,057-4%-2%0%-6%
Geriatrics$1921%1%0%3%
Hand Surgery$246-2%-1%0%-3%
Hematology/Oncology$1,7078%5%1%14%
Independent Laboratory$645-3%-2%0%-5%
Infectious Disease$656-4%-1%0%-4%
Internal Medicine$10,7302%1%0%4%
Interventional Pain Mgmt$9363%3%0%7%
Interventional Radiology$499-3%-5%0%-8%
Multispecialty Clinic/Other Phys$153-3%-1%0%-3%
Nephrology$2,2254%2%0%6%
Neurology$1,5223%2%0%6%
Neurosurgery$811-4%-2%-1%-6%
Nuclear Medicine$56-5%-3%0%-8%
Nurse Anes / Anes Asst$1,321-9%-1%0%-10%
Nurse Practitioner$5,1005%3%0%7%
Obstetrics/Gynecology$6364%3%0%7%
Ophthalmology$5,343-4%-2%0%-6%
Optometry$1,359-2%-2%0%-4%
Oral/Maxillofacial Surgery$79-2%-2%0%-4%
Orthopedic Surgery$3,812-3%-1%0%-4%
Other$48-3%-2%0%-5%
Otolarngology$1,2714%3%0%7%
Pathology$1,265-5%-4%0%-9%
Pediatrics$674%2%0%6%
Physical Medicine$1,164-3%0%0%-3%
Physical/Occupational Therapy$4,973-4%-4%0%-9%
Physician Assistant$2,9015%2%0%8%
Plastic Surgery$382-4%-3%0%-7%
Podiatry$2,133-1%0%0%-1%
Portable X-Ray Supplier$95-2%-4%0%-6%
Psychiatry$1,1124%3%0%7%
Pulmonary Disease$1,6540%0%0%1%
Radiation Oncology And Radiation Therapy Centers$1,809-3%-3%0%-5%
Radiology$5,275-6%-4%0%-10%
Rheumatology$54810%5%1%15%
Thoracic Surgery$352-5%-2%0%-8%
Urology$1,8104%4%0%8%
Vascular Surgery$1,293-2%-4%0%-6%
TOTAL$97,0080%0%0%0%
Source: 2021 Medicare Physician Fee Schedule Final Rule