Vein Care and the Proposed 2022 Medicare Cuts

Save Patient Access to Vein Care

We need your attention to a serious matter that we are all facing. Vein care practices are facing a payment crisis of a 22% reduction to the current 2021 Medicare payment across almost all of the superficial and deep venous CPT codes effective January 1, 2022. If this were to occur, we could expect commercial payments to drop, as these typically will mirror Medicare rates in time.

Our AVLS Healthcare Policy Committee has made it clear that the proposed 2022 Medicare reimbursement cuts will reverberate for years on office-based care if they are enacted as proposed. Many office-based clinics would not be able to survive once these cuts spill over to Medicare Advantage and non-Medicare payers. Could your practice?

Along with other partner specialties, AVLS is mobilizing to protect patient access and fair payment. The AVLS is executing now on both a regulatory front and a legislative front, but our efforts will require urgent funding that is above and beyond normal member dues. Your contribution will directly fund Federal emergency advocacy efforts to de fend fair payment and patient access to care.

The societal partners have engaged consultants and lobbyists familiar with CMS and Congress. The plan of attack is two-pronged:

1. Short-term action: The AVLS submitted comments to CMS requesting they do not institute the proposed changes until further analysis is completed. The Final Rule from CMS should be released around November 1. 
2. Long-term action: AVLS Members meet with their key members of Congress requesting an increase to overall funding for Medicare so that cuts do not need to be made. Medicare is mandated to be "budget neutral." For someone to get more, someone else gets less. It is proposed that specialists get less. 

Money makes this happen. Your donation will directly fund legislative initiatives and our consultants.

Get involved by providing the needed financial resources to allow the AVLS that benefits yourself and your colleagues. The Save Patient Access to Vein Care Defense Fund ensures appropriate vein care payment and your patients' access to care for years to come.

As an example, the proposed 2021-2022 CMS reduction in CPT code 36475 (Radiofrequency, 1st vein treated) will be about $302 in the office setting for every claim. To protect your practice and your patients, your AVLS Leadership is urgently asking you to contribute today. A contribution to the Save Patient Access to Vein Care Defense Fund could be the best investment you ever made.

Thank you for supporting the AVLS!

YES, Contribute Now to Protect my Practice and Keep Access to Care

Breaking Down the CMS Proposed 2022 Part B Regulations and Cuts: What You Need to Know

By Dr. Stephen Daugherty, AVLS Healthcare Policy Committee Chair, AVLS Board Director

Office-based vein doctors have experienced decade-long series of payments reductions for superficial vein procedures, and we are now facing a new set of unprecedented reductions that will challenge the survival of many outpatient vein care practices.

Medicare & Medicaid Services (CMS) recently proposed deep, 22% payment reductions to office-based vein care codes in the Proposed Physician Fee Schedule (PFS) Rule for CY2022. To be clear, these reductions impact a gamut of services in the office setting- arterial, IVUS, venous stenting, dialysis access, etc. These cuts are being driven primarily by a change in 2022 office-based RVU calculations in Medicare’s methodology that recognizes undervalued clinical labor data for office-based physicians. However, because of the budget-neutral nature of the national Part B pool, the CMS “pay-for” drastically reduces payment for these vein codes because of the proposed change in the way that the clinical labor data is incorporated into the Physician Fee Schedule. Part B resources are then shifted into other domains of medical care. This proposed CMS adjustment represents the additional reduction, on top of the RUC review of supplies and equipment that have taken place over the past decade or so, and the CMS project that went into effect in 2019 to adjust supplies and equipment costs for many items.

2022 Medicare Proposed Part B Fee Schedule Impact Table: Venous & Lymphatic Medicine Typical codes 2021 vs. Proposed 2022 Office Payment

Conversion Factor: CMS is proposing a 3.75% decrease to the Conversion Factor, from $34.89 to $33.58. The CF is used to multiply all NF RVU values to determine payment.

The AVLS will comment to CMS and is working with other provider organizations to urge CMS and Congress to retain the 3.75% increase to the conversion factor (CF) contained in the 2021 MPFS through FY 2023, as mandated by the Consolidated Appropriations Act, 2021 (P.L.116-260). The CAA was signed into law on 12/27/20.

Code	Abbreviated Code Descriptor	2021 NF Total RVU	2021 Avg. National Payment in NF	Proposed 2022 Total NF RVUs	Proposed 2022 Avg. National Payment	Payment % Change from 2021 vs. 2022
36465	NC Foam, Single Truncal Vein	44.29	$1,545	35.87	$1,205	-22.05%
36473	MOCA, 1st Vein	41.31	$1,441	33.34	$1,120	-22.32%
36475	RF, 1st Vein	37.76	$1,318	30.25	$1,016	-22.89%
36478	Laser, 1st Vein	31.74	$1,108	27.78	$933	-15.76%
36482	Chem. Adhesive, 1st Vein	55.63	$1,941	45.18	$1,517	-21.83%

NF = Non-Facility, or office site of service

View Impact for All Venous Codes

Additionally, because of the expiration of the late 2020 Congressional action that adjusted the Conversion Factor for 2021, payment will be further driven down because of the proposed 2022 Conversion Factor.

Procedural medicine stands opposed to these cuts, and AVLS is advocating for our members to obtain fair reimbursement in 2022 and beyond.

AVLS members who want additional detail about the proposed CMS payment changes may want to listen to the Vodcast that appeared in the Venous Edge online journal.

AVLS Patient Care Access and Fair Reimbursement Plan

By Dean Bender, AVLS Executive Director
Robert White, AVLS Director of Advocacy

Since the release of the CMS proposed Part B rule for 2022, the leadership and staff at AVLS have been hard at work understanding the impact on our field and developing a strategy to provide patient access and fair reimbursement while avoiding expected payment reductions over the next few years should this proposal go into effect. One thing that is very clear is that this is an advocacy challenge that will be fought on multiple fronts and that will require every member of the AVLS to become engaged at one level or another.

As of this communication, there are three major efforts underway:

1. Vein care clinicians are not the only doctors impacted by the proposed 2022 changes. We estimate thousands of providers will be negatively impacted across numerous specialties. As such, we expect impacted office-based doctors to partner together to provide CMS, the Administration, and Legislature with a united approach on how to deal with the proposed CMS reductions in total office-based RVUs.
2. Our regulatory response was developed and submitted. This effort led by the AVLS Health Care Policy standing committee developed our comment letter to CMS, providing an argument as to why the proposed rule will ultimately impact patient access to affordable quality care in addition to a large number of non-Physician staff having their jobs threatened. The AVLS's position is that the burden to pay for the CMS proposed increases in clinical labor should not be placed on office-based specialists. In support of our arguments, the AVLS invested in a series of research endeavors that provided us with the appropriate data to support our arguments as to the negative impact of the Proposed Rule.
3. Developing a legislative response. For the first time in AVLS history, we are faced with a crisis that will likely only be resolved through our Federal legislative process. To rectify this, we will need to develop relationships on Capitol Hill to enact changes to protect access to care for office-based vein care. AVLS staff has in place several options for legislative consultation for short-term and longer-term efforts. Such resources will potentially benefit the efforts of our coalitions but also the specific needs of our membership and field in general.

For the AVLS to make our case, we need to quickly fund the data research to support our arguments and to fund the legislative expertise needed to navigate Capitol Hill.

AVLS Regulatory Response

The first stage of our defense was to provide a direct response on behalf of our membership and the field in general to the Centers for Medicare Services (CMS). Our team developed a strategy to support the position that the 2022 Part B Proposed Rule should not be implemented as written because of the significant impact it will make on patient access to office-based specialty vein care. To support this argument, the AVLS is investing in two key pieces of economic research: 

• An economic research project from Baylor University is currently underway, modeling the impact of the Proposed Rule on CMS expenditures assuming patient care shifts from non-facility-based treatment (currently ~90% of all claims) to facility-based care, assuming that financial impact of 20-22% top-line revenue reductions will result in office closures.
• Additionally, a well-regarded health care data firm will analyze the financial impact of the Proposed Rule on highly weighted venous medicine practices. CMS estimates a negative impact of 6% for Vascular Surgeons on average and 8% for Interventional Radiologists as the reductions for certain codes are balanced by gains with others. This research will look at venous disease-specific practice impact where the majority of codes are being reduced by 20-22%. 

Read the AVLS Comments to CMS

Our Legislative Response

Because of the severity of the impact of the Proposed Rule, the AVLS also understand the need to approach this fight with Congressional support. As such, the AVLS has partnered with United Specialists for Patient Access (USPA), a professional association of office-based specialty interests dedicated to advocating for access and fair reimbursement for office-based care. USPA is a coalition of office-based specialties fighting to protect the payment structure of the Physician fee schedule. Led by Jason McKitrick and Liberty Partners, USPA is active on Capitol Hill, targeting congressional education. AVLS has taken an Executive membership position with the Coalition, providing a direct voice among the various members and encouraging other large venous-related groups to join the USPA. 

Additionally, we need every member to engage with their local legislators to educate them on the impact of the Proposed Rule and request their support in protecting the future of office-based specialty care. Please join our efforts by: 

• Contacting your member of Congress to sign the Rush-Bilirakis letter.
• Writing your member of Congress to share your concerns. 
• Contacting your member of Congress to set up a direct meeting and share your concerns face-to-face.
• Sending comments to CMS directly, urging them against implementing the Proposed Rule as written. 

What Can I Do?

Donate

It is imperative that AVLS develops the financial resources in preparation to act quickly once the CMS Final Rule is released in November. Please give to the Save Patient Access Defense Fund. If we get 300 members to donate their revenue from a single thermal ablation, then we will be able to build a defense fund that is ready to act!

Contribute Now

Thank you to those who have donated! As of October 26, the Save Patient Access Defense Fund has amassed $111,656 in donations from 116 donors. We want to thank our members who have joined our defense by not only reaching out to their networks and representatives but also by committing their finances to the Defense Fund. We ask you to join these leaders in our Society by donating today. 

Take our short practice survey.

To inform our Policy Committee with some additional information, we are asking office-based members to share their input by completing this short survey. Your responses will be kept confidential.

Take the Survey

Contact your Legislators

Engage with your member of Congress about this topic. Post this issue in all your office reception rooms and encourage your patients to also contact their Congress representatives! Discuss this issue with your patients if the opportunity presents itself. This is a critical patient access issue, and so it is right to discuss especially with your Medicare patients! Attend a district Town Hall to raise your concerns. Best of all, call and request a 20-minute-or-so meeting in the representative’s district office with the member and their staff. Make a random stop by your representative's district office! Get their attention any way you can.

Find my Senator

Find my Representative

Attached is suggested text that you can use in your email or request to meet. I recommend customizing your letter to your practice, such as location(s) and the number of staff you employ.

WebinarsRead about AVLS Member Dr. Sreenivas Reddy's Connection with his Congressman

AVLS Advocacy Webinar - Update on CMS Final Proposed Rule

November 10, 2021
8:00 PM EDT

The AVLS Advocacy Committee and our consultants will review and explain the Final 2022 Physician Fee Schedule for Part B services. We will also address our next steps as a Society and how you can get involved. 

Webinar Agenda

• Key Points from the Final Rule: What did CMS Say in Plain English? Dr. John Blebea
• Our Strategy to Date and Pivoting to Next Steps, Dr. Chris Pittman
• The Importance of Coalitions and Building Support, T. Jane'e Murphy, Community Consulting Partners, Inc.
• USPA and Capitol Hill Update, Jason McKitrick, United Specialists for Patient Access (USPA)
• What We All Will Need to Do to Get Congress to Act - Call to Action, Dr. Stephen Daugherty
• STOP CMS'22 Appeal Still Needs Your Support, Dr. Lornell Hansen

Register for Free

AVLS Advocacy Webinar - August 26, 2021

The AVLS Advocacy Committee hosted an informational webinar to update our membership about the Proposed 2022 Payment Rule on Thursday, August 26, at 8:00 PM EDT. Registration is free, and the webinar recording is restricted to AVLS Members only.

Watch the Recording

Connect on the MAC

Join the Conversation

If you have any questions or comments on this subject, please reach out to [email protected] or 510.346.6800.