Omnibus Bill Released: Only Partially Addresses Physician Payment Cuts

At the time of this writing, Congress is considering an “Omnibus” end-of-year spending package, which must be enacted by Friday, December 23 to avoid a government shutdown. The text was released by negotiators on Tuesday, leaving legislators with three days to review its 4,155 pages. The Omnibus will serve as the vehicle to address the looming 8.5% Medicare payment cut, which is a combination of a 4% PAYGO sequestration and an almost 4.5% reduction to the 2023 Medicare Physician Fee Schedule conversion factor.

The text currently under consideration fully averts the 4% PAYGO sequestration for 2023 and 2024, but does not technically eliminate this sequestration. Rather, the legislation pushes forward the “balance due” to 2025. While this ensures full relief of the 4% sequester for providers in the next two years, it also ensures that this sequestration will need to be addressed again by Congress before 2025. With regard to the Physician Fee Schedule conversion factor, the Omnibus covers only 2.5% of the 4.5% needed for 2023 and only 1.25% for 2024. That leaves Medicare providers with an approximately 2% cut in 2023. The impact for 2024 is less quantifiable since the conversion factor for that year is not yet known.

Among other Medicare provisions, the Omnibus extends by two years the telehealth flexibilities originally created pursuant to the COVID public health emergency and extends the safe harbor allowing coverage of telehealth services in high deductible health plans. The legislation also provides an extension at 3.5% of the expiring 5% bonus for providers in alternative payment models.

Finally, the Omnibus extends the existing 2% Medicare sequester (which is already in effect) by six months in 2032. In other words, Congress levied additional cuts on providers in 2032 to partially avert cuts to providers in 2023 and 2024, and to help pay for other spending priorities in the 1.6-trillion-dollar bill. Not surprisingly, the provider community has expressed frustration and disappointment at this legislation.

In the past year, lawmakers on both sides of the aisle in both chambers introduced legislation to offset the full cuts and exerted significant pressure on congressional leadership to ensure that the 4.5% conversion factor reduction was averted in full. In recent weeks, some lawmakers also expressed opposition to the budget gimmickry of offsetting near-term cuts with long-term cuts. However, the pressure of a looming government shutdown will ensure that a sufficient number of Members vote for the bill, even if they dislike provisions in it. Thus, the bill is expected to pass without changes to the Medicare provisions outlined herein, but CSRO will continue to monitor amendments and alert our members to any relevant changes, should they occur.

The continued annual reimbursement reductions combined with inflation have created a near-impossible business environment for physician practices, which in turn affects beneficiary access. In the year ahead, the physician community will aggressively push Congress towards long-term Medicare Physician Fee Schedule stabilization.

Advocating for You: CSRO Leads Discussion on Drug Administration Challenges, Ultrasound Coding

On December 19, CSRO led a multispecialty group of physicians and infusion providers in a discussion with CMS’ Center for Medicare (CM) and Center for Clinical Standards and Quality (CCSQ) on longstanding challenges with drug administration service payment and policy. Most of the conversation centered on “down coding” of complex drug administration, which the Medicare Administrative Contractors (MACs) had implemented through “local coverage articles” without input from clinicians.

As a result of CSRO advocacy, CMS issued Technical Direction Letters (TDLs) which “paused” the down coding temporarily while CMS works toward a long-term solution. The TDLs will not expire until CMS has promulgated rulemaking or program instruction (e.g., updates to its policy manuals) that permanently addresses the issue. CSRO has pushed for robust criteria that would account for AMA CPT requirements, Medicare valuation, and other clinical factors, including complexity of the patient population, all of which demonstrate that the administration of these medications warrant use of the chemotherapeutic administration codes. 

The multispecialty group also raised concerns about the Self-Administered Drug (SAD) Exclusion List, which they contend is discriminatory and hinders access to therapies for beneficiaries that are unable to administer themselves due to their condition. As rheumatologists know, medications often have two formulations; one that is administered in a physician’s office and reimbursed under Part B, and one that is self-administered by the patient and paid under Part D. However, when a medication is “usually” (i.e., 50% of the time) administered “by the patient,” CMS’ current policy manual directs MACs to place the drug on the SAD List, meaning Medicare will no longer pay for the provider-administered formulation under Part B.  

CSRO described issues with CMS’ definitions and criteria, which discriminate against Medicare beneficiaries who are unable to self-inject a medication. For example, CSRO raised concern that CMS uses a weighted average across all indications to determine Part D use, disregarding the fact that certain disease states make it more difficult for the patient to self-inject. CSRO also noted that many patients who utilize a self-injected Part D medication, are not self-administering; instead, they have a relative, friend, or clinical staff in the physician’s office, administer the drug. In fact, a survey conducted by Global Healthy Living Foundation (GHLF) revealed that 40% of Medicare patients fall into this category. Given all of these concerns, the groups urged CMS to revise SAD List criteria, as outlined in the Medicare Benefit Policy Manual, and offered ideas to help ensure more beneficiaries are able to access in-office medications. 

CMS recognizes the challenges with both of these issues and asked to meet with CSRO again in the beginning of January. 

Earlier in the day, CSRO leadership met with CMS CM staff to discuss concerns about neuromuscular ultrasound coding and billing following CMS’ recent consolidation of CPT 76881. CSRO noted that eliminating the professional and technical components mean that many rheumatology practices will no longer be able to provide this service to Medicare patients given they outsource the ultrasound interpretation and report in order to keep appointment wait times down. CMS did not commit to any “fix” by January 1, 2023, but acknowledged the complexity of the issue and committed to ongoing dialogue with stakeholders to better understand the issue.

Feedback Requested: Issues Impacting Rheumatology

CSRO is requesting input from the rheumatology community to gather information about the issues most impacting patients and practices.

Results from this survey, which will be shared at CSRO's National Town Hall, will help us understand the landscape of our community and better advocate for change. All feedback is needed by Sunday, January 15 – thank you for your consideration.

Take Survey

National Town Hall

Wednesday, January 25

4pm PT/ 5pm MT / 6pm CT/ 7pm ET

Virtual gathering via Zoom -

registration is required

2023 marks 20 years of advocacy for CSRO! Join us as we gather virtually with the rheumatology community to hear updates from CSRO's Government Affairs team, review the results from our Issues Impacting Rheumatology Survey, and engage in an open forum discussion on issues directly affecting you, your patients, or your practice.

The information gathered at this meeting enables us to better advocate for change at the state and federal levels and will help shape our policy priorities for the year ahead.


Support CSRO's Ongoing Advocacy Work: Give a Gift Today

CSRO is a 501c3 nonprofit organization dedicated to ensuring access to the highest quality care for the management of rheumatologic diseases. Advocacy is the cornerstone of CSRO’s mission and has a tremendous impact on a patient's access to care, disease management options, and quality of life, as well as the overall practice environment for rheumatology.

This past year, CSRO has met directly with lawmakers, provided on-the-ground resources, testified in state capitols, supported negotiations on legislation, sent letters of support, and generated grassroots campaigns – all in an effort to ensure access and affordability within the rheumatology community (find some highlights in our advocacy snapshots below).

Support our ongoing advocacy work and help make a difference by making a tax-deductible donation today.

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CSRO 2022 Advocacy Snapshots

Dr. Albert joins CSRO in testifying to provide the unique perspective of a local private practice rheumatologist

Advocates from around the country gather for a night of networking at CSRO's annual Advocacy Conference

CSRO joins fellow advocates in Wisconsin to support white bagging legislation

CSRO Immediate Past President Dr. Madelaine Feldman provides an official statement to the FTC on the effects of PBMs

CSRO joined the Michigan Rheumatism Society for their first Annual MRS Advocacy Day, made possible through the support of an advocacy grant from CSRO


Mark Your Calendar: CSRO's 2023 Events

CSRO's Fellows Conference: March 10-11, 2023

Help rheumatology fellows as they prepare for their future roles as physicians by encouraging them to attend CSRO's 2023 Fellows Conference – an annual event curated by rheumatologists specifically for rheumatology fellows.

CSRO's National Town Hall: January 25, 2023

2023 marks 20 years of advocacy for CSRO! Join us virtually for a National Town Hall to learn updates on our advocacy work and share about issues impacting you or your practice.

CSRO's Advocacy Conference: August 25-27, 2023

Mark your calendars to join us in Austin for CSRO's Advocacy Conference and celebration of our 20th Anniversary! 

Stay tuned for more details about how you can join us in celebrating our two decades of serving as the voice for rheumatology. Have memories of CSRO's founding? Email to share your story or photo with us.

Legislation Around the Country

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients – click here to view a full status report.

Be sure to check out our interactive legislative map tool for additional information about current policy in your state.

CSRO Resources for You

  • Payer Issues Reporting Form
  • Request assistance with any payer relation issues that may be impacting your patients or office.
  • Legislative Map Tool
  • Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.
  • Action Center
  • Use CSRO's Voter-Voice engagement platform to easily communicate and engage directly with your elected officials.
  • Policy Correspondence Archive
  • Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.
  • Career Center
  • Locate the perfect fit whether you're looking for new career opportunities or trying to find the right candidate.

Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at
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