Advocacy and Health Policy |

How Congress's Year-End Spending Bill Impacts Your Practice


Congress voted last night on an end-of-year package to avert a government shutdown, provide additional COVID-19 relief, and lessen pending payment cuts to obstetrician-gynecologists, among other things. 

  • Thanks to the tireless efforts of ACOG advocates, Congress acted to mitigate harmful payment cuts that were set to be implemented by the Centers for Medicare & Medicaid Services (CMS) on January 1, 2021. 
  • These cuts, set to go into effect in the midst of the ongoing COVID-19 pandemic, would have resulted in an estimated 7.4 percent cut to gynecologic surgical services for Medicare and Medicaid patients, and would have negatively influenced commercial payer reimbursement as well, negatively impacting access to care for all women. This win is building off of our years-long effort to avert cuts to both obstetric and gynecologic surgical care. The final payment rates have not yet been calculated; for physician payment updates, register at ACOG’s Payment Advocacy and Policy Portal
  • ACOG is still reviewing the full text of the 5,000+ page omnibus legislation, which included a number of additional provisions of importance to the practice of obstetrician-gynecologists, including:
    • A “fix” to surprise medical billing that protects patients from unanticipated medical bills while ensuring a balanced adjudication process that has an independent dispute resolution option intended to ensure physicians and insurers are on equal footing. Notably, arbiters cannot refer to public payer rates, including Medicare and Medicaid, in their adjudication, which often pay at lower rates than commercial payers, in their adjudication. ACOG has long advocated for an equitable solution to this issue and will continue work to ensure fair reimbursement for obstetrician-gynecologists.
    • Continuation and expansion of the Paycheck Protection Program (PPP), including $284 billion for first and second forgivable PPP loans and expanded allowable uses of funds to include personal protective equipment
    • An additional $3 billion in grants for health care providers for the Provider Relief Fund for health care related expenses or lost revenues that are attributable to the COVID-19 pandemic. Loans and grants have been advocated by ACOG to ensure obstetrician-gynecology practices can be sustained through the pandemic.
    • >Increased federal support for residency training, ending a nearly 25-year freeze by lifting the arbitrary cap on Medicare funding for new graduate medical education (GME) positions and adding 1,000 new Medicare-supported GME slots at both rural and urban teaching hospitals.
    • Extension of the Geographic Practice Cost Index (GPCI) in Medicare, to ensure equitable reimbursement for physicians living in rural areas
    • Funding for critical public health programs, including the National Health Service Corps, Community Health Centers, Teaching Health Centers GME Program, Special Diabetes Program, and Special Diabetes Program for Indians

Additionally, the legislation included increased federal support for women’s health research – an ask at the 2020 Congressional Leadership Conference – increased federal funding for the Alliance for Innovation on Maternal Health (AIM) Program, increased federal investment in state maternal mortality review committees, and established funding for a maternal mental health hotline. 

Unfortunately, Congress failed to include bipartisan, House-passed maternal mortality legislation in the year-end package. Read ACOG’s statement expressing our extreme disappointment. ACOG sincerely appreciates the years of advocacy and hard work by all of our members that helped us to elevate this important issue, and we will continue to fight to get these evidence-based policies across the finish line in the 117th Congress.