Washington Scene: STS Members Mobilize to Fight Reimbursement Cuts

STS News, Winter 2020 — The Society is pursuing all possible legal and legislative options to reverse cardiothoracic surgery payment cuts in the Physician Fee Schedule that the Centers for Medicare & Medicaid Services (CMS) finalized for 2021.

The fee schedule calls for reimbursement cuts of up to 8% for cardiothoracic surgery procedures. Cuts of this magnitude represent a very real threat to the financial viability of cardiothoracic surgeons’ clinical practices and, more importantly, could limit patient access to care.

What’s Behind the Cuts

In 2018, CMS began an effort to update the structure and valuation of office/outpatient evaluation and management (E/M) codes. Codes for E/M office visits cover everything from checkups to chronic disease management and typically are billed by primary care providers. A large number of E/M services provided by cardiothoracic surgeons traditionally are embedded in reimbursement for “global” procedures.

CMS claimed its revisions to the E/M codes would decrease administrative burden and increase reimbursement for physicians who most commonly provide these services. The agency also sought to create add-on codes that would further increase reimbursement for E/M visits that required additional time and complexity for primary care services and other non-procedural specialty care.

In the final Physician Fee Schedule, however, CMS increased reimbursement for E/M office visits without applying the same updates to postoperative visits that are bundled into global surgical payments. Because there is a set pool of money for Medicare payments, an increase to one type of service (E/M office visits) mandates cuts for other services—in this case, global surgical payments.

When asked, CMS provided no insight as to how it could justify cuts of up to 8% for cardiothoracic surgery. In fact, CMS indicated that it may further cut payments for cardiothoracic surgery by upwards of 20%, based on reports produced by the research firm RAND Corporation.

Cuts Continue Trend of Declining Reimbursement

These current reductions are even more substantial when viewed within the historical perspective of cardiothoracic surgery reimbursement over the past few decades.

Medicare reimbursement for the specialty has dropped precipitously since the late 1980s and institution of the resource-based relative value scale in the early 1990s. The practice of cardiothoracic surgery also has changed considerably since that time; the hospital employment rate among cardiothoracic surgeons is higher, self-reported physician burnout is higher, and recruiting new cardiothoracic surgeons is more challenging. The decline in reimbursement has been blamed, at least partially, for these changes.

It is critically important that legislators hear from STS members about why reversing these reimbursement cuts is essential to providing high-quality patient care.

CMS has attempted to reduce reimbursement for global surgical payments before. In 2014, when the agency was actively promoting bundled payments across all of medicine, it simultaneously proposed to change all 10- and 90-day global codes to 0-day global codes and require that surgeons bill separately for each individual postoperative visit they perform. CMS argued that surgeons were not actually providing the postoperative visits that are built into the global period.

STS joined with surgical organizations to oppose this change and helped persuade Congress to pass a law prohibiting CMS from changing reimbursement for global surgical services without adequate information on the number and level of postoperative visits being performed. 

How You Can Help

STS is actively communicating with Congressional allies and other medical/surgical specialties impacted by this latest CMS policy. All possible angles will be explored, including legislation that could mandate equitable payment updates or add more money to the Medicare program.

In addition, it is critically important that legislators hear from STS members about why reversing these reimbursement cuts is essential to providing high-quality patient care. See below for information on how you can become involved.

Under the final Medicare Physician Fee Schedule for 2021, cardiothoracic surgeons would see reimbursement for certain services such as coronary artery bypass grafting surgery fall by up to 8%—continuing a trend of declining reimbursement since the late 1980s. Payments could decline by up to 20% more if changes proposed by the RAND Corporation also are implemented by CMS.


Take Action Now

Encourage your legislators to reverse these reimbursement cuts! STS can help you with scheduling and provide briefing materials.

  • Schedule a phone call with your representatives or members of their health care teams to provide details on how these cuts may impact patient care.
  • Sit down with your lawmakers at their district offices and discuss potential legislative solutions that they can support.
  • Invite your legislators to visit your workplace and show them the value of the services that you and your team provide. Once scrubbed in, it’s impossible to ignore your message.

Contact STS Government Relations for more information and assistance.