Becker's ASC Review

13 ASC MANAGEMENT Will CMS physician pay cuts ever happen? By Laura Dyrda P otential Medicare pay cuts associ- ated with the 2010 sequestration have loomed large on Capitol Hill for the last decade, but lawmakers continue to kick the can down the road. e initial pay cuts were implemented in 2013 as part of the sequester cuts, with Medicare cutting physician pay 2 percent. But the cuts have been stalled to avoid lower- ing physician pay. Physicians again dodged the across-the-board reimbursement reduc- tions set for Jan. 1 when President Joe Biden signed a bill protecting current pay rates through March 31, 2022. Will the cuts ever go through? Or will they continue to be used as leverage in budget discussions perpetually? "ese automatic cuts should remind mem- bers of the needed reforms. Congress can get a head start on doing the right thing when it reconvenes early next year," American Medi- cal Association President Gerald Harmon, MD, said in December. e sequester cuts are now coupled with other reimbursement reduction efforts, total- ing about 9 percent, if legislators don't act to avoid them. It seems Congress and the president are content to use the pay cuts as a bargain- ing chip, with big consequences if they are implemented. Richard Menger, MD, assistant professor of neurosurgery and assistant professor of political science at the University of South Alabama, argued in an editorial published by e Hill that reducing physician pay, which comprises 20 percent of Medicare spending, would force more consolidation in the indus- try. Especially amid the pandemic, when many independent physician practices with tight margins suffered financially, CMS pay cuts would be devastating. e Biden administration hasn't been par- ticularly friendly to ASCs or independent physicians this year. "CMS penalized the healthcare industry by shiing procedures safely performed at ASCs to the hospital without much clinical evi- dence or outcome data," Chhaya Patel, MD, medical director of ambulatory anesthesia and assistant professor at Emory School of Medicine in Atlanta, told Becker's. "Another gut punch to the physicians [would be] the physician payment cuts in the midst of this pandemic at a time when physician practices are still recovering the personal and financial impacts of the COVID-19 public health emergency. We must continue to advocate for our patients to provide safe, accessible and cost-efficient care." n Surgery centers must give cost estimates to patients: 7 details By Laura Dyrda A SCs and physician practices are required to provide cost estimates for expected charges to self-pay patients when scheduling procedures or services as part of the No Surprises Act, which went into effect Jan. 1. There are other aspects of the law that don't apply to ASCs and physician practices, but the good faith estimate regulations do, according to a report from JDSupra, a legal analysis company. Seven things to know: 1. Patients are considered "self-pay" if they are uninsured or decide not to submit the claim to their insurance provider. ASCs are required to ask all patients about their payment plans and then provide estimates to self-pay patients accordingly. 2. ASCs and physician practices must have a written notice of self-pay patients' right to a good faith estimate of anticipated charges. The facility is required to post the notice in the office, on its website and on-site where services are scheduled. 3. Any discussion or question about the cost of services the patient may undergo should be treated as a "good faith estimate" request. 4. The ASC must provide a written good faith estimate com- plying with federal regulations to self-pay patients upon re- quest or when scheduling the primary service. The estimate must include the patient's name, primary service in clear language, an itemized list of services, diagnosis codes and anticipated additional services not reflected in the estimate. 5. The estimate must also provide a disclaimer that the actual charges may differ, and instructions on how the patient can dispute billed charges if they are at least $400 more than the initial estimate. 6. Good faith estimates must be provided within one day of scheduling a procedure if the procedure is scheduled at least three business days in advance. Facilities have three business days to provide good faith estimates if the procedure is scheduled at least 10 days in advance. 7. If ASCs or physician groups need to change the esti- mate, they must provide a change at least one day before services are rendered. n

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