CMS Proposes 4.4% Cut in Physicians’ Medicare Payments
CMS released its 2023 Physician Fee Schedule proposed rule Thursday, recommending lower payments for physicians under fee-for-service Medicare plans, as well as expansions related to behavioral health, cancer screenings, dental care, and patient access to accountable care organizations (ACOs).
The changes include a decrease in the conversion factor, a multiplier used to calculate physician reimbursement for fee-for-service payments under Medicare. The proposed conversion factor for the 2023 Physician Fee Schedule rule is $33.08, a decrease of $1.53 from last year, according to a CMS fact sheet.
The proposed conversion factor accounts for the statutorily required update of 0%, the expiration of a 3% increase in physician payments required by Congress, and the required budget neutrality adjustment to account for changes in relative value units, CMS said.
The recommendation to lower clinician payments follows a Medicare Payment Assessment Commission (MedPAC) report from March, stating that Medicare payments to physicians do not need to be increased next year, which did not sit well with physician groups.
Jack Resneck, Jr., MD, president of the American Medical Association (AMA), said that while his organization is still reviewing the proposed fee schedule, “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.”
“Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians,” he noted.
Additionally, the Medical Group Management Association stated that it “is incredibly concerned about the likely impact of the proposed 4.42% reduction to the conversion factor, especially in light of the financial uncertainty which medical groups have faced over the past two years stemming from the COVID-19 pandemic, inflation, and the staffing crisis.”
The proposed changes related to expansion of behavioral health, cancer screenings, dental care, and patient access to ACOs will likely be more warmly accepted by physicians and patients alike.
“At CMS, we are constantly striving to expand access to high quality, comprehensive health care for people served by the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure in a press release. “Today’s proposals expand access to vital medical services like behavioral health care, dental care, and cancer treatment options, all while promoting access, innovation, and cost savings in the Medicare program.”
Expanded Behavioral Health Coverage
The agency stated that it will aim to address the behavioral health provider shortage by proposing to allow a range of mental health practitioners, including licensed professional counselors, marriage and family therapists, and others to provide behavioral health services under general, instead of direct, supervision.
Additionally, CMS proposed bundling certain chronic pain management services into monthly payments to improve patient access. The agency also suggested covering opioid treatment and recovery services from mobile units, including vans, to increase access for people who are unhoused or living in rural areas.
Increasing Access to Colon Cancer Screening
Aiming to reduce barriers to getting a colonoscopy, CMS proposed that a follow-up colonoscopy after an at-home test should be covered as a preventive service, meaning that cost-sharing would be waived for Medicare patients. The agency also proposed to cover the service for patients 45 and older, in compliance with younger age recommendations from the U.S. Preventive Services Task Force.
Payment for Dental Services
CMS covers dental services that are integral to medically necessary services, and is offering to pay for dental care for new procedures. The agency proposed to pay for dental exams and treatments prior to an organ transplant, and is seeking comment on other medical conditions for which it should pay for dental services, such as cancer treatment or joint replacement surgeries.
Improving Opportunities for ACOs
CMS has proposed changes to the Medicare Shared Savings Program, a voluntary initiative that supports providers and hospitals who want to create an ACO. The agency wants to incorporate advance shared savings payments into certain ACOs, which can be used for Medicare patients’ social needs — one of the first times traditional Medicare payments would be permitted for such uses.
Additionally, the agency is proposing that smaller ACOs have more time to transition to downside risk, in which organizations have to pay back any money they lose from the program, aiming to promote growth in rural and underserved communities. CMS has also proposed a health equity adjustment to ACOs’ quality performance category to reward organizations for excellent care to underserved populations.
The National Association of ACOs applauded these proposed changes, commending CMS for “taking steps to reach its goal of creating a stronger Medicare by strengthening accountable care models and speed the movement toward value for all patients.”
The 60-day comment period for the agency’s proposal will close on September 6. The final rule will be released this fall.
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