CMS Cut to Primary Care Services in Nursing Facilities/Assisted Living/Home Health by Nearly 10% Is Unconscionable

Columbia, MD – AMDA – The Society for Post-Acute and Long-Term Care Medicine strongly opposes policy the Centers for Medicare & Medicaid Services (CMS) finalized on December 1, 2020, to cut payments for evaluation and management (E&M) services in nursing facilities, assisted living, and home health by nearly 10% effective January 1, 2021.

Physicians, nurse practitioners, physician assistants, and occupational/physical therapists who practice in these settings have put themselves at the highest risk caring for patients who have been the hardest hit by the COVID-19 pandemic. These clinicians face incredible physical and mental hardship, as many are forced to isolate from their families and suffer the consequences of contracting the virus themselves. Cutting these services at this time is simply unconscionable.

There are upwards of 50,000 unique visits billed to Medicare in the nursing home alone—that number grows significantly when assisted living and home health are included. Upwards of 17,000 clinicians practice exclusively in the nursing facility setting. Such cuts will force these practices to make hard choices that likely will lead to the worsening of an already crippling clinical workforce crisis for our nation’s most vulnerable citizens.

As a consequence, veterans, frail older Americans, disabled individuals, and many others may not have access to adequate care. Many will end up being re-hospitalized, which will impose significant additional costs to Medicare, reversing the significant progress made on reducing re-hospitalizations, and only serve to erode the quality of life and quality of care for these patients and residents. When combined with the fact that family members, who normally serve as an integral part of the care team, are restricted from seeing their loved ones, we must more than ever rely on our front line clinical caregivers to provide care and to communicate with families on the care being provided.

“It is inexplicable, in light of the surging COVID-19 crisis, that CMS has chosen to impose this drastic cut on the very clinicians who, at great risk to themselves and their families, have been battling this deadly virus at ground zero for the past 9 months,” said Society Executive Director Christopher E. Laxton, CAE. “Far from offering support and encouragement to our dedicated practitioners, this instead delivers a wound that may very well prove to be unsustainable—with tragic consequences for our nation’s nursing home residents and their families.”

Given the urgency of this matter, the Society is actively working with Congress on legislation that would suspend budget neutrality requirements that result in this cut. We urge Congress to act immediately to prevent cuts so that our seniors can continue to receive the care they deserve.

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AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.