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Last week CMS released their proposed fee schedule for 2022 now usually this is a non-event but not this year this year in addition to releasing the proposed fee schedule they released a number of changes to how CMS is going to pay doctors as well as the number of other things the biggest change a proposed change in the way office visits are reimbursed CMS is proposing to go from five levels to two in the new proposed fee schedule there'll be a payment for a level one code and then the same payment for levels two through five let's take a look at the numbers a little bit CMS are proposing that a level two will go from $45 to about $92 a level five on the other hand will go from about one hundred and fifty dollars today to ninety two dollars one getting a huge increase and the other one getting a huge cut now CMS is not proposing to spend any additional money their money or their expenditures would be roughly equal under either program what they're doing is in essence redistributing that money or redistributing income so let's take a look at the winners or losers first of all primary care internal medicine family practice net neutral both specialties would get a roughly the same amount of money in 2022 as 2022 where this really impacts is the specialists and what it does is it takes those specialists that tend to have shorter visits namely many other surgical specialties and some of the lower complexity non surgical specialties and it gives them more money and those specialties that end up having longer or more complex visits it takes money away from them but in perspective under this proposal dermatologists would get about a 25% increase in their Medicare reimbursement for office visits that's about 219 million dollars a year orthopedics would get a 13% increase ENT an 11% increase podiatry would get a 28% increase or another 226 million dollars a year who are the losers well the losers are specialties like cardiology it takes a six percent decrease oncology that takes a 10% decrease neurology and Rheumatology both take nine percent decrease is Neurology for example would lose about a hundred million dollars a year in revenue let's put that in perspective the average neurologist makes about two hundred fifty thousand dollars a year so if you cut a hundred million dollars out of the system it's like cutting four hundred neurologists now I didn't wasn't aware that we had four hundred watt neurologists just sitting around with nothing to do the next question that comes to mind is okay let's say this passes what's going to happen how is the marketplace going to react how our physicians going to react we all understand Newton's third law for every action there's an equal and opposite reaction and there will be with this as well I think there's a couple things that could.