Vein Forum

AVF leadership is working collaboratively with a group of professional societies to better understand the proposals and to have them changed! These rules are lengthy and complex. As we work through this administrative crisis, we believe it is important for our members to understand that there are many aspects of this proposed rule. While you are welcome to review the 804 page document of the proposed rule (published in the Federal Register on July 23, 2021 – Docket number CMS-1751-P) or the CMS fact sheet, the AMA has provided a summary that, though still a bit technical, provides a good summary of the potential impacts to the provider community as a whole.

Be assured that the Health Policy Committee and AVF Leadership are advocating on your behalf.

Mark Iafrati
Chair AVF Health Policy Committee

Dr. Monahan spoke with Staffers from California Senators Feinstein and Padilla, and Representatives McClintock, Barbara Lee, and Lieu. Dr. Iafrati met with Tennessee Representatives Good and Cooper, Tennessee Senators Blackburn and Haggerty and Virginia Senators Kaine and Warner.

These discussions were focused on four urgent issues with potential legislative fixes, all of which have currently drafted bills, and therefore provide opportunities for immediate ACTION.

1. Push back against poorly administered and burdensome Prior Authorization rules instituted by Medicare Advantage programs.
2. Address the looming shortage of Venous Specialists (and the overall physician Work Force) by increasing funded residency positions and increasing the pipeline of providers to fill the slots.
3. Roll back the proposed changes to Medicare Payments which unevenly and unfairly slash funding to venous providers (potentially >20% if your practice is primarily office based)
4. Provide for mental health services for medical providers.

Read below to learn more details on our proposed path forward then call, email, snail mail your Representatives and Senators to let them know how important these issues are to you.

1. Co-Sponsor and Support Passage of H.R. 3173, “Improving Seniors’ Timely Access to Care Act of 2021”
• Current prior authorization requirements for pre-approval of vascular ultrasound and other medical procedures under Medicare Advantage (MA) plans often delay the provision of critical treatment supported by evidence-based clinical guidelines. Delays in treatment can have severe consequences for patients, including those who have suffered a stroke or patients with a blood clot in their leg that could result in leg amputation.
• H.R. 3173 will standardize and streamline the prior authorization process under MA plans by automating the prior authorization process, increasing transparency, requiring real-time decisions by MA plans, ensuring prior authorization requests are reviewed by qualified medical personnel, and encouraging plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians under MA plans.
2. Co-Sponsor and Support Passage of H.R. 2256/S. 834, “The Resident Physician Shortage Act”
• The current nationwide physician workforce shortage is an urgent public health problem that is only going to get worse. The latest data from the Association of American Medical Colleges projects a shortage of between 37,800 and 124,000 physicians by 2034. A shortage of non-primary care specialty physicians of between 21,000 and 77,100 is also projected by 2034, including between 15,800 and 30,200 for surgical specialties. Furthermore, the COVID-19 pandemic has put additional serious strains on this workforce as it continues to respond to this national emergency
• H.R. 2256/S. 834, will help address the nationwide shortage of physicians and the acute shortage of vascular surgeons by adding 14,000 new Medicare Graduate Medical Education (GME) slots over seven years. This legislation will build on the 1,000 additional Medicare-funded residency positions included in the Consolidated Appropriations Act of 2021.
• H.R. 2256/S. 834 legislation defers loan repayment for surgical specialties, makes medical school more accessible and affordable, encourages appropriate Visa policies to ensure International Medical Graduates and medical students can study and practice medicine in the United States, and supports mental health services for physicians.
• Vascular residencies and fellowships are turning out about 160 new surgeons a year, but health economists predict this will be woefully inadequate and will result in a reduction of surgeons trained to deliver vascular care in the U.S. as some 65 million baby boomers enter the age group that suffers most from vascular disease. Vulnerable populations, such as the nation’s elderly and patients in rural and underserved areas, will be most adversely impacted by the growing physician workforce shortage.
3. Oppose Medicare Payment Reductions for Surgical Care Estimated to Result in a >9% Payment Cut
• Congress delayed the most drastic cuts for 2021, but last year’s action was only a temporary fix. Congress did this by adding a 3.75% Conversion Factor (CF) increase for all services — avoided significant disruptions to care for Medicare beneficiaries, supported small health care businesses — especially in rural and underserved areas and continuing the suspension of the -2% Medicare sequestration during the Public Health Emergency.
• Compounding these payment cuts are Medicare’s budget-neutral financing system and updates to the CF that have failed to keep up with inflation. The CF is the dollar 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. The CF today is only about 50% of what it would have been if it had simply been indexed to general inflation starting in 1998, when the single CF was established.
• Furthermore, vascular surgeons have seen a disproportionate decrease in inflation-adjusted reimbursement in comparison to other surgical specialties over the last decade. A recent study published in the Annals of Vascular Surgery reported that inflation-adjusted Medicare reimbursement rates for the 20 most common vascular surgical procedures decreased by more than 20% in the last decade, in comparison to an inflation-adjusted reimbursement rate decrease over the same period of 12% for general surgery and 8% for neurosurgery.
• Recent changes in the Physician Fee schedule, proposed by CMS have appropriately increased the Clinical Labor Staff Rates. Payment for these non-physician staffers is financed by decreases in the reimbursement for supplies and equipment in outpatient settings. These Practice Expense (PE) changes will have a disproportionately severe impact on vascular surgeons/venous providers who utilize office-based procedures and Office-Based Labs (OBLs). If unmitigated the impact to office based vascular practices could reduce reimbursement to these groups by > 20% in 2022. Given the downward financial impacts of recent years these changes would result in some practices and OBLs closing and others moving care back to more expensive hospital-based facilities. While there is no pending legislative fix for this issue, there are several legislative options which could address this issue. We will continue to work with relevant agencies and congress to address this Urgent issue.
4. Support/Co-Sponsor H.R. 1667/S. 610, the “Dr. Lorna Breen Health Care Provider Protection Act”
• Dr Lorna Breen was a NY Emergency Physician who after experiencing the strain of caring for COVID patients and becoming a COVID patient herself committed suicide. Her failure to obtain the necessary mental health support reveals a tremendous, short fall in our provider’s self-care system. Prevalence of physician burnout in the United States was 43.9% in 2017, which was higher than among other working adults. Physician burnout is recognized as a significant problem that has severe personal and professional consequences, including substance abuse, depression, suicide, poor clinical judgement and increased medical errors, decreased productivity, decreased patient satisfaction, and physician turnover. One of the major sources of physician burnout is compliance with time-consuming administrative burdens and red tape that do not add value to patient care or improve patient outcomes. The pandemic has only compounded these issues and added additional stress given the unprecedented challenges resulting from COVID-19.
• HR1667 funds programs and studies aimed to prevent suicide, burnout, substance use disorders, and other mental health conditions and identifying and disseminating best practices for reducing and preventing suicide and burnout among health care professionals, among other things.