SGO Secures Several Legislative Victories in Year-End Spending Package
The COVID-19 relief and omnibus spending bill for the current Fiscal Year (FY) 2021 signed into law by President Trump on Dec. 27 provides $1.4 trillion in funding for FY 2021 and an additional $900 billion fiscal stimulus to renew certain COVID-19 relief programs and fund other COVID-related activities. SGO advocacy was very successful this year in achieving several important legislative priorities in the year-end COVID relief omnibus spending bill, including relief from the Medicare cuts to physician payments for 2021, $35 million in research funding for ovarian cancer at the Department of Defense (DoD) and for the first time, adding endometrial cancer as an eligible cancer under the Peer-Reviewed Cancer Research Program at the DoD. Specifics on each of these items are as follows:
Mitigation of Medicare Payment Cuts
SGO in conjunction with our colleagues in the surgical community was successful in advocating for Congress to mitigate the Medicare payment cuts finalized under the Calendar Year 2021 Medicare Physician Fee Schedule (MPFS) that were scheduled to take effect on Jan. 1, 2021. These payments cuts, necessitated by Medicare budget neutrality rules, were promulgated by the Center for Medicare and Medicaid Services (CMS) to offset the payment increases for office-based Evaluation and Management (E/M) services and other spending increases under the fee schedule. Congress included several provisions to mitigate the Medicare physician payment cuts in the year-end omnibus package.
Congress took action to stop the implementation of the CMS proposed and finalized new add-on code for complex primary care services (G2211) for three years, until Jan. 1, 2024. The savings from the delay will be applied across the fee schedule and are intended to reduce the budget neutrality cuts by 35-40%. When SGO joined with others in the surgical community to review the impact of this add-on code last fall, eliminating the code would have changed the amount of the payment reduction to a positive 1% payment increase for the specialty of gynecologic oncology, overall, due to the increase in the E/M payments.
Congress gave additional relief for health care providers from the COVID pandemic by providing a one year 3.75% increase to all payments for physician services under the MPFS in calendar year 2021. CMS has recalculated the MPFS conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is $34.89, which represents about a $2.50 increase to the conversion factor of $32.41 that was previously set in the CY 2021 MPFS final rule. Also helpful to physicians are provisions to extend the 2% Medicare sequester moratorium for three months, through March 31, 2021, and reinstate the 1.0 floor on the work Geographic Practice Cost Index (GPCI) through Dec. 31, 2023.
Depending on code-specific changes in payment that may be occurring in 2021, e.g., changes in individual code RVU values, these actions taken by Congress will mitigate most of the cuts to surgical procedures this year and result in sizable increases for E/M services.
Other provisions in the year-end package intended to provide COVID-19 relief include new money for the Paycheck Protection Program (PPP) and the opportunity for businesses to reapply for a second time, if they meet the employee number and revenue loss criteria. Follow SGO communications for additional details on this and other new initiatives that may be of interest as more information regarding these programs becomes available.
Robust Federal Funding for Ovarian and Endometrial Cancer Research
The Ovarian Cancer Research Program at the DoD will receive $35 million in FY 2021 due to SGO advocacy, making this the second year in a row the program has received this robust funding level. And, for the first time, SGO successfully secured the addition of endometrial cancer to the final list of eligible cancers for research study under the DoD Peer-Reviewed Cancer Research Program that is funded at $115 million for FY 2021. This will bring new resources to enhance our understanding of the pathogenesis of endometrial cancer, which will help address the significant disparities of the disease.
Congress provided $42.9 billion for National Institutes of Health (NIH) in FY 2021, a $1.25 billion – or +3% – increase over the enacted FY 2020 level. For reference, the Biomedical Research Development Price Index [BRDPI] is projected at 2.4% in FY 2021. The spending package includes a funding increase of no less than 1.5% above fiscal year 2020 to every NIH Institute and Center.
The National Cancer Institute (NCI) is getting a specific increase of $37.5 million to increase the pay-line for their grants. SGO advocacy secured passage of FY 2021 report language under the NCI that highlights endometrial cancer as a research priority and directs the NCI to initiate research studying disparities in endometrial cancer and to conduct clinical trials that will lead to improved individualized treatment approaches for endometrial cancer. The specific report language is below:
Endometrial Cancer – The Committee is concerned that both the incidence and mortality rates for endometrial cancer are rising, with a survival disparity for Black women. The Committee believes that a renewed emphasis by NCI on endometrial cancer research is needed to facilitate early detection and optimal treatments and outcomes for all women, including minority populations. The Committee urges NCI to study endometrial cancer disparities, including biologic differences in tumor type, molecular mechanisms, pathogenesis, and tumor microenvironment, and to conduct clinical trials to better define appropriate therapy for a precision medicine approach to endometrial cancer. The Committee requests an update on NCI’s activities regarding endometrial cancer in the fiscal year 2022 Congressional Justification, including progress made in incidence and survival rates by ethnicity.
The year-end spending package contains other provisions of interest under the Centers for Disease Control and Prevention (CDC), including $10 million for Johanna’s Law to raise awareness about the five main types of gynecologic cancer, $12 million for the ovarian cancer control program that funds prevention activities and $225 million for the Breast and Cervical Cancer Program.
Medicaid Coverage of Clinical Trial Costs
Congress provided some good news for patients by approving one of SGO’s legislative priorities, the Clinical Treatment Act. Passage of the Clinical Treatment Act as part of the year-end package will now guarantee coverage of the routine care costs of clinical trial participation for Medicaid enrollees with life-threatening conditions. This legislation was one of the topics SGO members discussed with federal lawmakers during SGO Capitol Hill fly-ins over the last two years and its passage represents an important advocacy win.
These legislative achievements demonstrate the importance of SGO advocacy. SGO members can be proud of the impact SGO advocacy is having on improving patient care and strengthening the voice of gynecologic oncology on Capitol Hill. Thank you to all SGO member advocates who responded to action alerts and participated in the Capitol Hill fly-ins and other advocacy activities that made these achievements possible.