CMS proposes a 3.4% cut to Medicare payments

The proposed 2024 Medicare Physician Fee Schedule sets a 3.4% reduction to the conversion factor for Medicare payment rates, further increasing the gap between practice expenses and reimbursement. The proposed conversion rate would be $32.7476.

CMS proposed fee schedule cut: ©Timon - stock.adobe.com

Other highlights of the CMS proposal include:

• Telehealth reimbursement for patients in their homes would be reimbursed at the normally higher non-facility rate.
• Telehealth services listed on the Medicare Telehealth Services List would continue to be covered and reimbursed through 2024.
• Continued allowance of direct supervision by a practitioner through real-time telecommunications through 2024.
• Permitting split or shared E/M visits to be billed based on either history, exam, or medical decision-making, or alternatively, time, through the end of 2024.

In addition there were several proposed changes to various practice model programs:

• All three MIPS reporting options would see an increase in the performance threshold from 75 points to 82 points.
• Five new MIPS Value Pathways would be added: women's health, prevention and treatment of infectious disease; quality care in mental health/substance use disorder; quality care for ear, nose, and throat; and rehabilitative support for musculoskeletal care.
• The Medicare Shared Savings Program would see several changes, including the revision of the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the program.
• Elimination of the 3.5% APM incentive payment at the end of the 2023 performance year (2025 payment year,) and transitioning to a Qualifying APM conversion factor in the 2024 performance year (2026 payment year.)

“At CMS, our mission is to expand access to health care and ensure that health coverage is meaningful to the people we serve,” said CMS Administrator Chiquita Brooks-LaSure, in a statement. “CMS’ proposals in the proposed physician payment rule would help people with Medicare navigate cancer treatment and have access to more types of behavioral health providers, strengthen primary care, and for the first time, allow Medicare payment for services performed by community health workers.”

“CMS continues to demonstrate commitment to advancing health equity and building a stronger Medicare program,” said Meena Seshamani, MD, CMS deputy administrator and director of the Center for Medicare, in a statement. “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health, and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.”

The proposed cut generated pushback from many professional physician organizations – the summaries of the reactions can be found here.