AMA calls on Congress to prevent cuts to Medicare physician payment system

The AMA is calling on Congress to prevent cuts to the Medicare physician payment system following the HHS’ and CMS’ finalization of the 2023 Physician Fee Schedule.

“The Medicare payment schedule released today puts Congress on notice that a nearly 4.5 percent across-the-board reduction in payment rates is an ominous reality unless lawmakers act before Jan. 1,” AMA President Jack Resneck Jr., MD, said in a press release, noting the rate cuts “would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians.”

The 2023 Physician Fee Schedule’s (PFS) conversion factor is $33.06, a $1.55 decrease from the 2022 PFS’ conversion factor of $34.61. The decrease is higher than the proposed ruling this past July, which had a $1.53 reduction.

According to CMS, the rate reflects the 0% statutorily required update for the calendar year of 2023, the expiration of the temporary 3% supplemental increase in PFS payments for the calendar year of 2022, and the statutorily required budget neutrality adjustment to account for changes in payment rates.

Resneck said it was apparent that when the payment system was proposed, the rates “not only failed to account for inflation in practice costs and COVID-related challenges to practice sustainability but also included the damaging across-the-board reduction.”

Resneck additionally pointed out that physician Medicare payments are set to be cut by nearly 8.5% in 2023, impacted by a 4% PAYGO sequester, which would “severely impede patient access to care” due to forced practice closures and additional pressures on those that remain open.

“The AMA will continue working with Congress to prevent this harmful outcome,” he said.

CMS said the 2023 PFS is also set to expand coverage for both behavioral health services and opioid treatment programs while finalizing changes to the Accountable Care Organizations (ACOs), such as allowing smaller ACOs more transition time to downside risk and incorporating advance shared savings payments to certain ACOs.

Other enhanced services include colon cancer screenings — with the minimum age lowering from 50 to 45 years — and dental services, where Medicare will pay in more circumstances and in situations where a service in integral to a beneficiary’s health condition.

References:

• AMA: Fee schedule reminds Congress that cuts threaten patient access. https://www.ama-assn.org/press-center/press-releases/ama-fee-schedule-reminds-congress-cuts-threaten-patient-access. Published Nov. 1, 2022. Accessed Nov. 2, 2022.
• HHS finalizes physician payment rule strengthening access to behavioral health services and whole-person care. https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole. Published Nov. 1, 2022. Accessed Nov. 2, 2022.
• Physician fee schedule. https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched. Accessed Nov. 2, 2022.