STS News, Fall 2019 — The Society’s advocacy efforts regarding extracorporeal membrane oxygenation (ECMO) recently paid off in a major way, but challenges still lie ahead for physician reimbursement.
In August, the Centers for Medicare & Medicaid Services (CMS) confirmed that reimbursement for ECMO will be based on patient acuity and resource needs, rather than cannulation approach, for the fiscal year that began on October 1. This decision reverses detrimental changes to hospital coding and reimbursement for ECMO enacted last year and follows months of advocacy by STS, the Extracorporeal Life Support Organization, and a broad group of stakeholders.
Coming off this important win, STS members face a new call to arms. In the proposed rule for the 2020 Physician Fee Schedule, CMS stated plans to cut reimbursement for cardiothoracic surgery by up to 8%. The agency has refused to modify the value of postoperative visits in the 10- and 90-day global surgical periods commensurate with updates to office/outpatient evaluation and management codes, improperly lowering the value of the global surgical period relative to other services in the Medicare Physician Fee Schedule, violating current law by creating specialty differentials, and ignoring recommendations from nearly all medical specialties. And that’s not all—CMS also is considering additional cuts to cardiothoracic surgery reimbursement of more than 20%.
STS has joined a coalition of surgical specialties criticizing the CMS proposal and also has submitted its own comments denouncing the proposed cuts. More help is urgently needed, however. It will take active engagement from all STS members to fend off these latest attacks on the specialty. Visit sts.org/keycontact to find out how you can connect with your Congressional representatives and urge them to take action on these important issues.
CMS is expected to release the final Fee Schedule this fall.