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WASHINGTON -- Physicians will see a nearly 4% cut in the "conversion factor" used to determine their fee-for-service Medicare payment under the released late Tuesday afternoon by CMS.

The conversion factor is the multiplier that Medicare applies to relative value units (RVUs) to calculate reimbursement for a particular service or procedure under Medicare's fee-for-service system. Due to budget neutrality changes required by law, as well as the expiration of a 3.75% temporary 2021 payment increase, the calendar year 2022 PFS conversion factor is $33.59, a decrease of $1.30 from the 2021 PFS conversion factor of $34.89, CMS on the final rule.

Some Physician Groups Unhappy

The 4% cut was less than last year's 10% cut, but it's still a decrease -- and physician groups weren't happy about it. The final rule "is a reminder of the financial peril facing physician practices at the end of the year," said Gerald Harmon, MD, president of the American Medical Association (AMA), in a statement. "The AMA is strongly advocating for Congress to avert this and other looming cuts to Medicare physician payments that, overall, will produce a combined 9.75% cut for 2022. This comes at a time when physician practices are still recovering the personal and financial impacts of the COVID public health emergency. Congress is beginning to recognize that this financial instability could limit health care access for Medicare patients. The clock is ticking."

The American Society for Radiation Oncology (ASTRO), which represents physicians, nurses, biologists, physicists, radiation therapists, dosimetrists, and other healthcare professionals who specialize in treating cancer patients with radiation therapy, also expressed disapproval. "We are deeply disappointed that the Biden administration failed to reverse excessive cuts in the Medicare fee schedules that will strip significant resources from radiation oncology and undermine the administration's own goals to bring an end to cancer," said Laura Dawson, MD, chair of the ASTRO board of directors, in a statement. "These cuts will endanger patient access to cancer care. Treatment facilities may be forced to cut services or close, which will exacerbate health disparities."

The Surgical Care Coalition, which includes a variety of medical groups whose members perform surgery, also spoke out against the cuts. "Amid the ongoing pandemic, it's critical now more than ever to protect patients by stopping these cuts and working toward a long-term solution to stabilize the healthcare system," noted John Ratliff, MD, chair of the Washington committee of the American Association of Neurological Surgeons, a coalition member, in a statement. "Patients have already delayed important preventative care like cancer screenings due to COVID-19. These cuts will further delay care to our nation's seniors."

He added that the conversion factor cut combined with automatic Medicare cuts "will slash Medicare payments to surgeons by nearly 9% beginning January 1, 2022. As COVID-19 cases and hospitalizations have already caused Americans to delay needed care, these cuts will continue to strain health care systems nationwide."

Applause in Some Corners

Not everyone was unhappy, however. Although the American Academy of Family Physicians (AAFP) decried the conversion factor cut, the group expressed approval of several other provisions in the rule. "We're pleased CMS is ... increasing payment rates for vaccine administration and chronic care management services," AAFP President Sterling Ransone, Jr., MD, said in a statement. "This will facilitate Medicare beneficiaries' access to recommended vaccines and care management services and enable family medicine practices to continue providing these high-value services."

In addition, "we are encouraged that this final rule will ensure permanent coverage of tele-mental health services in beneficiaries' homes after the end of the COVID-19 public health emergency (PHE)," he continued. "These services have been a lifeline for many beneficiaries during the pandemic. The AAFP looks forward to working with Congress and the administration to ensure ongoing coverage and fair payment of comprehensive primary care services via telehealth, including audio-only visits, after the end of the PHE."

The National Association of Accountable Care Organizations (NAACOS) was pleased that CMS delayed implementation of changes to accountable care organizations' (ACOs) quality reporting and measurement criteria for 3 years. "NAACOS has cited numerous potential negative consequences to patient care among the many reasons why such a rapid shift to electronic clinical quality measure reporting was bad policy," said Clif Gaus, ScD, president and CEO of NAACOS, in a statement. "We appreciate CMS listening to ACOs, providers, and the health IT vendor community on the need for more time and additional changes."

Gaus also applauded the agency's decision to cut in half the amount that ACOs must secure as a financial guarantee when they move to risk-based models, such as the Medicare Shared Savings Program (MSSP). "We hope to see more of this type of burden reduction from the agency across other aspects of the MSSP," he said.

Payments for Occupational and Physical Therapy Assistants

Other provisions of the final rule include:

• New modifiers -- CQ and CO -- for paying under Part B for physical and occupational therapy services provided by physical therapy assistants and occupational therapy assistants when they are appropriately supervised by a physical or occupational therapist.
• Direct payments to physician assistants (PAs) for professional services that they furnish under Part B beginning January 1. Currently, Medicare must pay the appropriate employer or contractor for the PA's services, but under the new rule, PAs may bill Medicare directly for their services and also can incorporate with other PAs and bill Medicare for PA services.
• Coverage of medical nutrition therapy services furnished by registered dietitians and nutrition professionals when the patient is referred by a physician; the rule also establishes the professional qualifications for these practitioners.
• Expanded coverage of outpatient pulmonary rehabilitation services paid under Medicare Part B to patients who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least 4 weeks. "This goes beyond CMS' Physician Fee Schedule proposed rule, which would have focused the expanded coverage to those hospitalized with COVID-19," CMS said in the fact sheet. CMS also temporarily extended coverage for certain cardiac and intensive cardiac rehabilitation services available via telehealth for people with Medicare until the end of December 2023.

Also on Tuesday, CMS released final payment rules for the , as well as for the .

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