Doctors will take a 1.25% pay cut next year under a proposed rule on Medicare’s physician fee schedule, promoting requirements that tie reimbursement rates to inflation.
The Centers for Medicare and Medicaid Services proposed on Thursday to reduce the overall payment rate by 2024, but increase reimbursement for primary care, among other services. Under the proposed rule, CMS would reduce the Medicare conversion factor by 3.34%, the benchmark used in conjunction with relative value units. Relative value unit factor in the specified industry the value of a procedure, the cost of practice, and the cost of negligence—each weighted and adjusted for geographic region.
Physician fee schedules have not kept pace with inflation, unlike other payment mechanisms such as inpatient and outpatient reimbursement models. As a result, physician associations have lobbied Congress to overhaul the payment system.
Dr. Jesse Ehrenfeld, president of the American Medical Association, said in a statement: “Motivation is building for reform. By the AMA’s calculations, he said that Medicare’s doctor payment has already been paid off. 26% decrease from 2001 to 2023. “Doctors are one of the only providers that don’t automatically inflate inflation,” says Ehrenfeld.
Tochi Iroku-Malize, president of the American Academy of Family Physicians, asked Congress in a statement to “issue an annual inflation update to help ensure physician pay rates keep pace with The cost of practicing is increasing.”
In April, House lawmakers introduced a bipartisan bill that would link doctors’ fees to the Medicare Economic Index, the government’s measure of inflation in the cost of medical practice. The House Committee on Energy and Commerce Health Subcommittee is reviewing the bill. The Medicare Payments Advisory Committee made a similar recommendation in January.
Although physician associations describe the proposed cuts as unachievable, they praise the proposal to increase primary care and the proposed changes to responsible care organizations. duty.
Under the proposal, CMS would amend the financial standards and quality reporting requirements in the Medicare Shared Savings Program. The agency estimates the proposed rule will increase participation in the Medicare Shared Savings Program by up to 20% next year, in part by taking into account beneficiaries seeking primary care through schools. nurse practitioners, physician assistants, and clinical nurse specialists.
“[The proposed rule] solve some problems that [the National Association of ACOs] has been advocating, including improvements to reporting quality, fairer benchmarking policies, a smooth transition to a new risk adjustment model, and enhanced payout retention for new ACOs transitioning to risk, helping ACOs serve high-cost beneficiaries and others,” said Clif Gaus, president and chief executive officer of the National Association of ACOs.
CMS also proposes a number of provisions designed to increase access to behavioral health care and enhance reimbursement for patients with chronic conditions. The agency will allow marriage and family therapists and mental health counselors to enroll in Medicare. The proposed rule would also increase payments for crisis care, substance use disorder treatment and psychotherapy.
CMS proposed extending a model designed to enhance care for patients with diabetes under Medicare in underserved communities. The agency will provide an additional payment that it says will better recognize resources related to clinic visits for complex patients.
In addition, the agency will pay for caregiver training to assist patients with certain illnesses and introduce new reimbursement mechanisms for community health and group care workers, along with payment money for navigation services for cancer patients.
The comments are due on September 11. The final rule is expected later this fall.
