With 5,593 pages and $2.3 trillion, the Consolidated Appropriations Act of 2021 (CAA21) is the longest and largest spending bill ever passed by Congress. It combines $900 billion for COVID-19 stimulus relief with the $1.4 trillion of 2021 annual omnibus bill spending — the later including 12 separate annual appropriations bills.¹ The bill impacts almost everyone, and for radiologists and medical professionals, the impact is profound.

Throughout 2020, the ACR led a coalition representing more than a million providers to shape the E/M legislation, resulting in a positive impact on its patients and members (learn more at acr.org/EM). The advocacy effort was critical as radiologists were faced with a potential reduction in reimbursement of more than 10% — resulting from budget-neutrality–mandated reductions in the Medicare Conversion Factor (MCF) due to increases in E/M coding changes proposed by CMS. The ACR has a strong history of legislative advocacy, but this unprecedented multilateral effort resulted in several provisions that were positive for patients — as well as radiology and the broader house of medicine. The provisions included:

• Increasing the Medicare Physician Fee Schedule (MPFS) by 3.75% for CY 2021
• Suspending the 2% payment adjustment (sequestration) through March 31, 2021
• Reinstating the 1.0 floor on the physician work Geographic Practice Cost Index through CY 2023
• Delaying implementation of the “inherent complexity” E/M add-on code (G2211) until CY 2024

Together, these changes resulted in a 2021 MCF of 34.8931 and represents a 3.32% decrease for 2021, compared to the 10.2% decrease previously published by the CMS Final Rule in December. Our patients and physicians welcome these positive adjustments by members of Congress and also extend our appreciation for the increase in graduate medical education funding that was included in CAA21.

However, you will note that the four adjustments made are not permanent and will result in a phased-in approach of the full 10.2% MCF reduction in absence of additional action by either CMS or Congress. This legislation provides temporary relief to our physicians and practices that have been negatively impacted by the pandemic, but the adjustments do not offer durable solutions. The reductions mandated by budget-neutrality due to E/M revaluation are still scheduled for implementation.

The ACR has a strong history of legislative advocacy, but this unprecedented multilateral effort resulted in several provisions that were positive for patients — as well as radiology and the broader house of medicine.

In addition, it is expected that the initial revaluation of outpatient office visit services will prompt consideration of other E/M services throughout the MPFS. If several additional services are increased in value to gain parity with the outpatient visits, or if these increases are expanded to the global surgical payments, there will be further budget-neutrality–mandated reductions in the MCF that will negatively affect those providers who do not perform those services. The potential for a substantial and enduring impact looms large across the entire MPFS.

The ACR is already examining all potential avenues to further address this issue and will be communicating with members as more information and opportunities become available. The coalition of medical providers that stood together will continue to work on behalf of patients and physicians to ensure that we maintain appropriate, accessible, and equitable access to care — not only during the pandemic but in the recovery and years to follow. The Commission on Economics strongly agrees that the increase to those who provide E/M services is appropriate; however those payment increases should not be at the expense of the much smaller group who do not — especially when such drastic reductions could have a negative impact on available services and patient access.

This year will not be like 2020. We will not be facing a direct challenge to our reimbursement in 2021. However, now we will need to maintain our strong relationships with others, in both the house of medicine and the legislature, while working to expand our influence. The temporary relief provided through direct increase in payments across the entire 2021 MPFS has introduced the potential for relative payment reductions to many more providers in 2022 — and should increase the potential size and urgency among those groups that did not participate in previous advocacy efforts leading up to the passage of CAA21.

The ACR is counting on its members to stay engaged and remain active as the issues unfold. While we cannot expect another landmark legislation at the end of this year, we can start working together now to ensure that the end of 2021 will mark a significant improvement in the MCF — compared to where we ended in 2020.