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Damocles sword averted? Perhaps…
  1. Reade De Leacy1,2,
  2. Joshua A Hirsch3
  1. 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  3. 3 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
  1. Correspondence to Dr Reade De Leacy, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; reade.deleacy{at}

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On November 5, 2021, the Centers for Medicare and Medicaid (CMS) issued the final rule for the Medical Physician Fee Schedule (MPFS) for calendar year 2022. The MPFS 2022 included an update of the wages for clinical labor staff.1 This is the first such wages update since 2002 and represents an important step to equilibrate costs of hiring and retaining nurses, medical assistants, and other critical members to the healthcare team with the 2022 reality. On the face of it, this reform would seem equitable, but the update will probably have a significant and negative impact on other medical specialties and their Medicare/Medicaid patient populations, potentially limiting access to services and changing the environment where those services would be provided.

CMS normally offers a proposed rule for the MPFS in the summer. Following this early release, they typically would receive a flurry of comments from various organizations, to which the Society of NeuroInterventional Surgery might also contribute. Then, in the November the final rule is released. In this year’s proposed rule, CMS shocked many when having fallen years behind, indicated that clinical labor cost would be updated over the course of 1 year.2 Although the ruling appeared superficially reasonable, the devil in the details remained the seemingly ever-present concept and consequences of budget neutrality. Clinical labor costs reflect one of three components, which together represent direct practice expense inputs (DPEIs). The other two components are medical supplies that are not separately reimbursed and large practice equipment …

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  • Contributors Both authors contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.