ACP, AMA raise concerns over proposed cuts in 2023 Medicare Physician Fee Schedule

The ACP said it was encouraged by many provisions outlined in the proposed Medicare Physician Fee Schedule for 2023; however, both ACP and the AMA expressed concern over cuts to physician payments, which would take effect Jan. 1.

CMS proposed a 2023 Physician Fee Schedule (PFS) conversion factor of $33.08, a reduction to the 2022 conversion factor of $34.61, according to the agency.

“This conversion factor accounts for the statutorily required update to the conversion factor for CY 2023 of 0%, the expiration of the 3% increase in PFS payments for CY 2022 as required by the Protecting Medicare and American Farmers from Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in Relative Value Units,” CMS said in a press release.

Medical leaders condemn proposed cut

In a recent statement, AMA President Jack Resneck Jr., MD, said that it was “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,” Resneck said. “We will be working with Congress to prevent this harmful outcome.”

ACP President Ryan D. Mire, MD, FACP, also called for efforts to prevent the cuts from going into effect, adding that “it is also imperative that we find a long-term solution that addresses the structural problems in Medicare that cause repeated issues with payments under the fee schedule.”

“ACP will continue to advocate with Congress and the administration on both short and long-term solutions,” he said in a press release. “We will be further analyzing the details and impact of the proposed rule for next year and sharing our feedback with CMS.”

‘Promising areas’

ACP noted, however, that there are “promising areas” of the CMS proposals. For example, the agency proposed changes to the Medicare Shared Savings Program that “would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening and dental care — particularly in rural and underserved areas,” according to a CMS press release. These changes include advance shared savings payments for ACOs that are new to the Shared Savings Program and provide care to underserved populations. The ACOs could use the funds to hire behavioral health practitioners up front and address social needs of Medicare beneficiaries such as food and housing, CMS said.

“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 said in the release.

ACP said these changes look promising because of the “inclusion of changes to address social drivers of health and improve health equity.”

Regarding other changes, Mire said ACP is “particularly glad to see that CMS included the increased value for evaluation and management (E/M) codes used in inpatient settings in the fee schedule.”

“The changes in these codes, combined with the changes made to outpatient E/M codes in 2021, are significant in recognizing the value that internal medicine physicians contribute to their patients and our health care system across a variety of health care settings,” Mire said.

In addition to the increased value for E/M codes, ACP said the proposed PFS includes an implementation delay for changes to the way that physicians are billed for E/M services that are provided jointly with a qualified health care professional.

“ACP is relieved that this recommendation is in line with concerns previously expressed to CMS and will allow for additional time to better understand the potential impact these changes would have on physicians and other health care professionals,” the organization said in the release.

ACP also applauded a proposed extension for many telehealth services that were made available during the public health emergency. Some flexibilities, including certain audio-only visits, may be extended for 151 days after the end of the public health emergency, CMS said.

“The increased use of telehealth services has been vital to providing care to my patients during the COVID-19 pandemic, but it can also serve as a tool to better meet the needs of patients in non-emergency times,” Mire said in the release. “Allowing the expanded role for telehealth to continue has the potential to enhance patient-physician collaboration and increase access to care. We believe that telehealth should continue to be an important component of health care delivery.”

References:

• AMA: Medicare payment schedule rule threatens patient access. https://www.ama-assn.org/press-center/press-releases/ama-medicare-payment-schedule-rule-threatens-patient-access. Published July 7, 2022. Accessed July 12, 2022.
• Calendar Year (CY) 2023 Medicare Physician Fee Schedule Proposed Rule – Medicare Shared Savings Program Proposals. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program. Published July 7, 2022. Accessed July 8, 2022.
• CMS proposes physician payment rule to expand access to high-quality care. https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-expand-access-high-quality-care. Published July 7, 2022. Accessed July 12, 2022.
• Internal Medicine Physicians Encouraged by Proposals in 2023 Medicare Rules. https://www.acponline.org/acp-newsroom/internal-medicine-physicians-encouraged-by-proposals-in-2023-medicare-rules. Published July 8, 2022. Accessed July 12, 2022.
• Strengthening behavioral health care for people with Medicare. https://www.cms.gov/blog/strengthening-behavioral-health-care-people-medicare. Published July 7, 2022. Accessed July 12, 2022.