To protect America’s health infrastructure, eliminate budget neutrality

In policy and in health care, the threat of unexpected consequences is real and potentially life-threatening. As obstetrician-gynecologists observe Gynecologic Cancer Awareness Month this September, we encourage policymakers and health policy experts to recognize that COVID-19 and government payment cuts are impacting our patients in ways we could not have previously imagined — and that existing budget neutrality laws are exacerbating the problem.

Approximately 100,000 women are diagnosed with some form of gynecologic cancer — cervical, ovarian, uterine, vaginal or vulvar — in the United States every year. All women are at risk for gynecologic cancer, and most of us will or already know someone who has been personally affected by it. 

The global pandemic has had a significant effect on diagnosis and treatment of gynecologic cancer. For months, many OB-GYNs, including gynecologic oncologists, across the country were forced to delay cancer screenings, diagnostic tests and surgeries to avoid spread of the virus and conserve health care services for patients hospitalized with COVID-19. This wait impacted the quality of our patients’ lives when they were in need of assessment and possible treatment. It also left OB-GYNs with the massive costs associated with maintaining their practices without being able to offer the comprehensive care women so desperately needed and with additional costs of adopting their clinical practice to recommended COVID-19 guidelines.

COVID-19 has forced us to reckon with the shortcomings of our health care system and changed the way we deliver care. Necessary investments in telehealth helped to safely connect patients to their clinicians, but have also drawn on limited resources, leaving government agencies and private insurers to grapple with the long-term sustainability of telehealth services. 

Now, as the pandemic continues, private insurers reportedly are considering reverting back to pre-public health emergency practices of prior authorizations, claim denials and other barriers and burdens for OB-GYNs. The crisis continues and women’s health is jeopardized. 

In the midst of this, the Centers for Medicare & Medicaid Services (CMS) is moving forward with 2019 policies that, in part, would cut the average payment for gynecologic surgery by more than 7 percent. 

In 2019, CMS finalized a policy to increase Medicare payment rates for office and outpatient visits beginning in 2021. However, due to a law that mandates that Medicare spending must remain budget neutral, increasing payment for office visits will result in cuts to surgery payments. 

These cuts will be felt across the system, since Medicaid, TRICARE, the Department of Veterans Affairs and private insurers typically base their rates off of those established by CMS for Medicare. And this doesn’t only impact gynecologic surgeons; those in other specialties, as well, including cardiothoracic, orthopedic and vascular surgeons, are impacted too.

As we face a global pandemic and the resulting upheaval to America’s health care system, now is not the time to cut payments to our nation’s health care professionals who have worked diligently to save lives and help contain the spread of the virus. 

The existing budget neutrality requirements mean that when needed support is provided in some parts of the health care system, it must be always be offset by cuts to other vital services. Unfortunately, this zero-sum game means that the country’s essential, emergency investment in telehealth could further decimate the private practice of gynecology and leave women facing new barriers to getting the care they need. 

America’s health care infrastructure is not immune to the financial woes imposed by the pandemic. Budget neutrality laws are creating another crisis where there does not need to be one. 

To ensure that the United States has a foundation for care after the pandemic ends, Congress must waive budget neutrality rules now.

Eva Chalas, M.D. FACOG, FACS is president of the American College of Obstetricians and Gynecologists.