Another year, another proposed fee schedule cut from Uncle Sam

CMS released its proposed 2023 Medicare Physician Fee Schedule rule and it’s more bad news for doctors. If approved, it would cut the conversion factor by 4.42% ($1.53) to $33.0775.

The reviews from doctor groups were not surprising.

“It is immediately apparent that the rule not only fails to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also includes a significant and damaging across-the-board reduction in payment rates,” said Jack Resneck Jr., M.D., president of the American Medical Association, in a statement. “Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians. We will be working with Congress to prevent this harmful outcome.”

Likewise, the Medical Group Management Association expressed its concerns about the pay cut and it’s possible effects on patient access to care.

“These proposed cuts, coupled with the 4% PAYGO sequestration scheduled to take effect on Jan. 1, 2023, will have a detrimental impact on group practices, with 58% of recently surveyed groups indicating they are considering limiting the number of new Medicare beneficiaries served,” said Anders Gilberg, Senior Vice President, Government Affairs at MGMA, in a statement.

CMS has also proposed permitting some telehealth services to remain on the Medicare Telehealth Service list for 151 days after the expiration of the Public Health Emergency, something the MGMA applauds.

“MGMA appreciates the continued efforts from CMS to ensure cohesion of post-pandemic policies for medical group practices. The extension of regulatory Medicare telehealth flexibilities to align with the 151 days of congressionally extended telehealth policies will ensure practices have the ability to continue furnishing the highest quality care to patients,” Gilberg said.

CMS is also proposing changes to make it easier for practices to participate in ACOs. It is proposing to incorporate advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs. This is one of the first times Traditional Medicare payments would be permitted for such uses, and is expected to be an opportunity for providers in rural and other underserved areas to make the investments needed to become an ACO and succeed in the program.

CMS is also proposing that smaller ACOs have more time to transition to downside risk, further helping to grow participation in rural and underserved communities. CMS is also proposing a health equity adjustment to an ACO’s quality performance category score to reward excellent care delivered to underserved populations. Finally, CMS is proposing benchmark adjustments to encourage more ACOs to participate and succeed, which would help achieve the goal of having all people with Traditional Medicare in an accountable care relationship with a healthcare provider by 2030.

CMS also proposed the following:

• Maintaining the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year while adding five new Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023.
• Extending flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time until 2024.
• Expanding access to behavioral health by permitting marriage and family therapists, licensed professional counselors, addition counselors, and others to furnish behavioral health services under general supervision instead of direct supervision.
• Creating an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.

The final 2023 PFS rule is expected by Nov. 1, 2022.