10/01/2020

The 2021 Medicare Physician Fee Schedule Proposed Rule and the Medicare Coverage Modernization Act, H.R. 3654

How These Two Seemingly Unrelated Topics Converge to Show Chiropractors Are at a Severe Disadvantage in the Medicare System

Contact Senator Stabenow, Senator Peters, and your congressperson about the 2021 Medicare Physician Fee Schedule proposed rule here.

Get Your Patients Involved! Download the MAC’s handout on this issue and give to all your patients!

For the past few weeks, MAC leadership has been telling you about the 2021 Medicare Physician Fee Schedule proposed rule and the huge cuts in store for the chiropractic profession, if it is implemented as proposed. During the current congressional session, we have also been asking you to contact your member of Congress and ask them to co-sponsor H.R. 3654, the Chiropractic Medicare Coverage Modernization Act. What the proposed rule makes crystal clear is how critical passage of H.R. 3654 is to the chiropractic profession moving forward.

The 2021 Medicare Physician Fee Schedule Proposed Rule

In August, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2021 Medicare Physician Fee Schedule. Under the proposed rule, the conversion factor would be reduced from $36.09 to $32.26. While this alone would bring down fees, reimbursement of the relative value units (RVUs) for CPT® codes 98940, 98941, and 98942 would also be reduced by an additional 10%. In total, if implemented as proposed, chiropractors will see an actual payment decrease of more than 19%, a crippling hit that most providers could not absorb under normal circumstances, much less during the current pandemic-related economic downturn.

H.R. 3654 – The Chiropractic Medicare Coverage Modernization Act

H.R. 3654 would allow Medicare beneficiaries to access the chiropractic profession’s broad-based, non-drug approach to health care. This bipartisan legislation, currently co-sponsored by Michigan U.S. Representatives Bill Huizenga, Tim Walberg, Fred Upton, John Moolenaar, and 78 of their congressional colleagues from across the nation, defines a chiropractor as a “physician” in the Medicare program and provides patient access to all Medicare-covered benefits allowable under a chiropractor’s state licensure. In Michigan, this would include manual manipulation of the spine and extremities, evaluation and management services, diagnostic imaging, and utilization of other non-drug approaches that have become an important strategy in national efforts to stem the epidemic of prescription opioid overuse and abuse.

How These Issues Converge

The reduction in reimbursement associated with the 2021 Medicare Physician Fee Schedule proposed rule is the result of congressionally mandated budget neutrality to accommodate for new spending associated with the implementation of changes to Evaluation & Management (E/M) coding payments to many provider types. This Budget neutrality mandate basically creates “winners” and “losers” among provider types, as CMS is looking to reduce rates for many providers to offset the 2021 payment increases for E/M services.

Unfortunately, in this proposed rule, chiropractors are losers.

While other health care providers are also facing reimbursement cuts, they can recoup these funds by taking advantage of other provisions of the proposed rule, especially expanded E/M codes and telehealth services. But there is a sad truth at play here…

Because chiropractors are limited to one service in Medicare – medically necessary manual manipulation of the spine to correct subluxation – we are shut out of the E/M code value increases found in the proposed rule. And, since we cannot perform manual manipulation without physical contact with the patient, we are shut out of expanded telehealth services, too. The end result: Chiropractors are disproportionately harmed by these payment reductions.

Here’s where the importance of passing H.R. 3654 becomes clear: By allowing chiropractors to bill for additional services – such as the newly expanded E/M codes – chiropractors could have made up some of the decreases found in the proposed fee schedule. As it is, however, chiropractors are being asked to absorb a cut of nearly 20% so that other groups can make more. It is completely unfair for CMS to attempt to achieve budget neutrality by offsetting increases to some provider groups on the backs of the nation’s chiropractors.

Get Involved!

The MAC Executive Committee, Insurance Relations Committee, Government Relations Committee, and Legal Affairs Committee are all firmly committed to a grassroots campaign to urge Congress to waive budget neutrality for the 2021 Medicare Physician Fee Schedule. 

If you want to avert these massive cuts, you need to get involved and join this effort. The MAC has made it easy for you to send a message to your lawmakers and to get your patients involved, too! If these cuts are allowed to take effect, chiropractic practices across Michigan and the United States will either have to provide care to Medicare beneficiaries at a loss, or, because we cannot opt out of the program, stop seeing Medicare patients altogether. This may cause some practices to actually close their doors. And, all this at a time when patients are more and more seeking health care that foregoes invasive procedures like surgery and dangerous, addictive prescription opioids for pain relief. This is bad policy, and Congress needs to hear from us now.