Congress needs to protect physicians from Medicare cuts

As a physician, and a pathologist by specialty, every day I oversee hundreds of tests that will determine whether a patient is diagnosed with COVID-19, cancer, chronic kidney disease, or one of the countless other life-changing diseases. My expertise and that of my colleagues determine treatment decisions for patients that have life or death consequences.

Yet, over the last several months the coronavirus caused us to re-examine much of what we learned and the ways in which all physicians practice medicine. To say any single one of us was fully prepared for this is, at best, a stretch. The learning curve for medical professionals, health payers, and government regulators continue to be steep.

While physicians, laboratory scientists, nurses and other health professionals have been on the frontlines, Congress and regulators took some very important, immediate steps to help enhance clinicians’ abilities to care for patients.

Removing barriers to the use of telemedicine, temporarily increasing payment rates, making Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) available to physicians, and providing economic relief to hospitals and health systems, all helped to stabilize the health care system as it was hit by the twin forces of a pandemic and drastically reduced preventive and elective care.

Now that many immediate and critical needs have been addressed, the government’s triaging needs to focus on the longer term, but still very real threats to care that are on the horizon. Last year the federal government decided, beginning in January 2021, that it would enact payment reductions to all non-evaluation and management (E/M) services. In laymen’s terms, that means in January 2021 physicians who do not traditionally provide office visits, like pathologists, radiologists, and anesthesiologists will be paid much less for doing the same job they did a week earlier. For pathologists, the cut amounts to about eight percent less next year. 

The destabilizing impact of these cuts will occur at a time when physician practices, particularly pathology laboratories, are struggling to survive. A recent survey of laboratory directors accredited by the College of American Pathologists showed that anatomic pathology services, such as tissue biopsies plunged, and laboratory revenues fell an average of 50 percent as patients stay away from their doctors’ offices because of COVID-19 fears.

The Medicare cuts next year could put laboratories of all sizes out of business, reducing access to services and potentially delaying health care delivery. For rural residents, where hospitals and physicians are less common, these reductions may mean a total loss of pathology services.

Congress has the ability to eliminate this cut to non-E/M services by waiving the budget neutrality requirements that were imposed due to pay increases for office visits. Doing so will provide a critical reprieve for pathologists and other physicians facing substantial payment reductions.

Addressing this issue should not wait until the last minute. Physicians need to be able to engage in long-range planning with some certainty. We cannot wait until the 11th hour to know if we will have the resources to invest in the equipment, training, or even hiring that will help us simultaneously respond to the pandemic and provide diagnoses for patients in need of other care.

Over the next several months, Congress will be considering additional aid packages to help our country rebound from COVID-19’s economic devastation. By including a waiver to the budget neutrality requirements that are driving the cuts in any of these aid packages, Congress will be supporting the laboratories that are critical to bringing this country closer to defeating COVID-19.

As members of Congress survey the damage to their states and our country, I hope they will recognize the importance of eliminating the cuts to non-E/M services so that the physicians we need to help fight the COVID-19 pandemic are once again able to rise to society’s call.

Patrick Godbey, M.D., is president of the College of American Pathologists, Northfield, Ill.