MGMA to Congress: Act now to prevent Medicare cuts

MGMA and leading health organizations wrote to Congress expressing concern over the impending Medicare sequester cuts. Specifically, the letter asks Congress to act before April 1, 2021, to extend the 2% Medicare sequester moratorium and prevent the projected 4% Medicare spending cut scheduled to begin next year due to "Pay-As-You-Go," or PAYGO, statute reductions. Without further congressional action, the 2% Medicare sequester moratorium will end after March 31, and an additional 4% cut could be triggered due to the cost associated with the American Rescue Plan and its effect on government spending.

MedPAC recommends no payment update for physician services in 2022

On Monday, MedPAC released its March report on Medicare payment policy, which recommended no payment update for physician services in 2022. MedPAC serves as an advisor to Congress, however its recommendations are not binding. MGMA issued a statement expressing disappointment with the recommendation. Physician practices are subject to annual increases in staff salaries, rent, and supplies. Without a modest annual payment update to keep up with the cost of inflation, practices will ultimately be forced to make difficult decisions about Medicare participation.

MedPAC said it does not anticipate any long-term effects related to the public health emergency that would warrant changing the annual update to Medicare’s fee schedule for 2022. MGMA believes it is too early to assume that medical practices will not continue to experience financial challenges stemming from the COVID-19 pandemic next year, or an acceleration in post-pandemic practice-cost inflation.

Medicare increases payment for COVID-19 vaccine administration

This week, the Biden administration announced that Medicare will be increasing reimbursement for administering the COVID-19 vaccine. Effective for vaccines administered on or after March 15, 2021, the national average payment rate will be $40 to administer each dose of a vaccine. This represents an increase from approximately $28 to $40 for the administration of a single-dose vaccine and an increase from approximately $45 to $80 for the administration of two-dose vaccines. The final payment rate will also vary depending on the furnishing entity and geographic adjustments. 

Even with the news of increased Medicare reimbursement for COVID-19 vaccine administration, MGMA has heard from many practices about difficulty obtaining vaccine doses for their patients. MGMA has called on the administration to include medical group practices in COVID-19 vaccine distribution strategies.

Apply now for Primary Care First Model 2022 participation

CMS released a request for applications for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions may apply. PCF Cohort 2 will have five performance years and is scheduled to begin Jan. 1, 2022. The deadline for practice applications is April 30, 2021.

PCF is based on the Comprehensive Primary Care Plus Model and qualifies as an advanced alternative payment model.