The Ongoing Fight to Stop Medicare Physician Cuts

ASPS has a longstanding history of advocating for fair Medicare reimbursement for physicians. Recently the Society found itself fighting harmful cuts again, however, the source of the reductions was unexcepted – the $1.9 trillion American Rescue Plan.

Background: Triggering PAYGO

When President Biden signed the American Rescue Plan into law in March, many providers found cause for celebration, as it included provisions designed to keep their patients safe and prevent their practices from closing. However, the package has also delivered unintended consequences with significant implications for the physician community.

The significant cost of the American Rescue Plan triggered provisions of the Pay As You Go (PAYGO) Act of 2010, which prohibits new legislation changing taxes, fees, or mandatory expenditures from increasing projected federal deficits. In the event that a policy does increase the deficit, across-the-board cuts in selected mandatory programs are automatically set into motion. Set to take effect on September 30, 2022, the cuts triggered by the American Rescue Plan include spending reductions in Medicare of an estimated 4% or $36 billion.

An ongoing fight

Prior to this blow, providers were already operating under threat of an across-the-board 2% cut to Medicare – known as sequestration – which Congress previously suspended through March 31, 2021. Since the passage of the American Rescue Plan, ASPS has worked diligently to prevent the 2% cuts to physicians' Medicare payments, which were scheduled to take effect on April 1, 2021.

In anticipation of the cuts taking effect, the Society submitted comments to Congress calling for Medicare sequestration relief during the pandemic, and ASPS staff aggressively advocated on the issue in meetings with members of Congress, including those on the prominent House Energy and Commerce and Ways and Means Committees.

When Congress failed to meet the April 1 deadline to prevent Medicare sequestration, CMS announced a temporary pause on the processing of claims after April 1 in anticipation that Congress would soon address the issue. ASPS provided notice of the agency's action via a Plastic Surgery News Special Bulletin to all U.S. members.

When the Senate took action on the issue and passed legislation to stop the 2% cut, ASPS quickly mobilized members via a grassroots alert to members asking surgeons to contact members of the House and ask them to act urgently and pass the bill.

On April 14, the Society's efforts and those of the Alliance of Specialty Medicine were rewarded as the House voted to pass the measure, eliminating the 2% cut to all Medicare payments through the end of 2021. To offset the cost of this moratorium, the bill increases the fiscal year 2030 sequester cuts. Soon after, President Biden signed the bill into law.

A long history of standing up to Medicare cuts

ASPS's advocacy on sequestration and PAYGO is just the latest example in a long line of efforts to combat Medicare cuts to physicians. ASPS was one of the few physician groups to oppose the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and most recently, the Society joined a broad coalition of physician groups that successfully secured the adoption of provisions in the end-of-the-year spending package that would stop an approximate 7% cut to plastic surgery. ASPS has also worked with the Alliance of Specialty Medicine to call on key House and Senate healthcare committees to consider greater reforms to MACRA.

The road ahead

Despite the 2% Medicare sequestration moratorium, a clear path to addressing the larger PAYGO 4% Medicare cut remains elusive. In a recent letter to Congressional leadership, ASPS and other Alliance of Specialty Medicine members urged lawmakers to act quickly to extend the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including the 4% Medicare spending sequestration, stemming from the American Rescue Plan.

ASPS and its partners will continue to fight for physicians' rates to ensure they are dictated by fair market prices rather than politics