WASHINGTON — Physician groups have expressed concern over what one group says is a “substantial” reduction in Medicare fee-for-service physician payments, according to the 2023 final rule released Tuesday by the Centers for Medicare and Medicaid services ( CMS).
The 2023 Medicare Physician Fee Schedule includes a conversion factor reduction of 4.5% – the multiplier that Medicare applies to Relative Value Units (RVU) to calculate reimbursement for certain Medicare fee-for-service systems service or program. After a budget-neutral adjustment required by law, CMS explained that the final conversion factor for the 2023 fee schedule was $33.06, down $1.55 from the conversion factor for the 2022 fee schedule of $34.61. The figure of $33.06 is slightly lower than the conversion factor of $33.08 suggested in the proposed rule. ) called the 4.5% drop “expected” but “substantial.” These changes cannot wait until the next Congress, it added. “MGMA looks forward to working with Congress and the Administration to mitigate these cuts and develop sustainable payment policies that allow physicians to focus on treating patients, rather than scrambling to open their doors.”
Transition to Value-Based Care
CMS said in a fact sheet that it wants to accelerate the transition to Value-Based Care and “Reversing certain trends,” including the number of beneficiaries assigned to Accountable Care Organizations (ACOs). In particular, the agency wants to increase the number of beneficiaries of a specific type of ACO called a Medicare Shared Savings Plan (MSSP), whose enrollment CMS says has “plateaued.”
Data have shown that access to MSSPs is underrepresented among high-spending populations—including sicker patients who spend more per capita on Medicare—and among minority populations. , including Black, Hispanic, Asian Pacific Islander, and American Indian/Alaska Native beneficiaries. The fact sheet noted that none of these groups were more likely to be assigned to a shared savings plan than non-Hispanic white beneficiaries.
To this end, the agency is finalizing policies to facilitate shared savings payments to low-income ACOs, ACOs with no experience in performance-based risk, newcomers to shared savings programs, and those who care about underserved populations , referred to as “advance investment payment”.
“As more beneficiaries enroll in Medicare Part D Low Income Subsidy (LIS), qualify for both Medicare and Medicaid, and live in areas of high poverty, these advances will Increases,” or some combination of these factors, CMS says, “are allocated to ACOs where these funds will be available to address social and other needs of the Medicare population.”
Made some telehealth changes permanent
Regarding telehealth, the agency reiterated its intention to respond during the COVID-19 Public Health Emergency (PHE ) after the end of the pandemic, to extend certain telehealth provisions enacted during the pandemic for a period of time to allow data collection, with an eye toward making certain services permanently available via telehealth; doing so is also consistent with the Omnibus Appropriations Act of 2022, according to the CMS fact sheet (CAA).
“These policies, such as allow telemedicine services to be provided in any geographic area and any origin location setting (including the beneficiary’s home); allow certain services to be provided over audio-only telecommunications systems ; and allow physical therapists, occupational therapists, speech-language pathologists and audiologists to provide telehealth services, which will remain in place during the PHE for 151 days after the conclusion of the PHE,” the fact sheet states.
In addition, the 2022 CAA also defers in-person visits for mental health services provided through telehealth until 152 days after the end of the PHE.
The rule also includes a proposal to allow physicians to continue to indicate billing using location of service or POS if the service is part of a face-to-face v isit, and includes a modifier to indicate that the service is actually is provided via telehealth.
Recognizing the need to expand access to behavioral health for Medicare beneficiaries, CMS proposes the following changes:
Responses from other stakeholders to cuts
vs. Like MGMA, the Association of American Medical Groups (AMGA) is also urging Congress to reverse the cuts to the conversion factor, arguing that it will further pressure medical groups and health system members “who are struggling with inflation, increased supply costs, and an unprecedented medical workforce.” Shortages while facing financial headwinds”
“This reduction, combined with upcoming pay-as-you-go (PAYGO) cuts and the recently reimposed Medicare quarantine, will see Medicare pay Group and health system cost reductions of more than 10 percent beginning January 2023,” AMGA said in a release. (PAYGO is a 2010 statute that requires any new bill to be budget-neutral and not increase forecast deficit.)
“This brinkmanship of annual Medicare payments is unsustainable and does not support a better AMGA President and CEO Jerry Penso MD, adding , such cuts would hurt patients by limiting members’ ability to invest in infrastructure, technology, and staff while members transition to value-based care.
The National Association of ACOs (NAACOS) praised many of the CMS changes, especially those for MSSPs.
“Today’s final change to Medicare’s largest ACO program is a win for patients and will definitely help providers deliver responsible care to more beneficiaries,” NAACOS President and Chief executive Clif Gaus, ScD wrote in a release. “Overall, we believe this final rule will increase engagement with responsible care organizations that have already saved our health system billions of dollars.”
Yet , Gaus did raise lingering concerns over using an “anticipated executive growth factor” as an ACO benchmark or spending target, which he said would hurt more than a third of ACOs. “Instead, we’re asking for more collaboration between the CMS and ACO communities to build better bridges for a more sustainable benchmarking strategy.”
Shannon Firth has covered health policy since 2014 as MedPage Today’s Washington correspondent. She is also a member of the site’s corporate and investigative reporting team. Follow
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