Payment, administrative reforms among ACP's top priorities in 2023
Key takeaways:
- ACP is urging Congress to link Medicare physician payments to inflation based on the Medicare Economic Index.
- Despite the telehealth extension, payment and practice expense costs remain a concern.
SAN DIEGO — This year, ACP will focus on supporting several hot policy issues in health care, including payment reform, telehealth and administrative updates, according to a speaker at the ACP Internal Medicine Meeting.
“It’s time to change the conversation,” Brian Outland, PhD, the director of regulatory affairs at ACP, said during the session.
Payment reform
According to AMA data, Medicare physician payments have declined 26% from 2001 to 2023 when adjusted for inflation.
The Medicare Access and CHIP Reauthorization Act of 2015 — or MACRA — was created to replace the Medicare sustainable growth rate, but it “isn’t doing what it was intended to do” with CMS’ Merit-based Incentive Payment System and alternative payment models, Outland explained.
“We’re still looking at working and making MACRA the entity that it needs to be in helping you to get where you need to be,” he said. “As we look at MACRA, the physician community continues to push for this change, including the inflationary update to the physician fee schedule [PFS].”
In a position paper published last year, ACP addressed these issues by advocating for hybrid payment models with fee-for-service components that should be sustained and have payment amounts increased. It also called for models to be effective and evidence-based while being feasible for physicians in all types of practices.
In addition, ACP urged Congress to add a Medicare Economic Index update to the PFS and immediate relief from budget neutrality cuts — both highlighted during the presentation as key actions moving forward.
Telehealth
Telehealth provision waivers offered by CMS during the COVID-19 public health emergency were extended through Dec. 31, 2024, as part of the bipartisan omnibus bill signed at the end of last year. Despite this, payment for these services remains uncertain.
“Even though it’s extended, Medicare is saying, ‘Should we continue to pay for it after the pandemic?’” Outland said. “What is the payment? Is it parity with in-office visits or not? How do we work through that?”
the answer, he said that ACP is looking through practice expense costs for telehealth vs. in-person visits.
The organization is also examining the implications of telehealth on patient health. Recent research has found that more than 60% of patients did not require an in-person visit for at least 3 months following a primary care telehealth visit, indicating that telehealth visits may be able to replace many in-person visits.
“What’s the impact telehealth has on physicians as well as the patient? We’re looking at what is the most appropriate manner it should be used,” Outland said.
Administrative updates
Finalized at the end of 2022, the 21st Century Cures Act aimed to enhance technology and interoperability within the administrative realm of clinical settings.
The law, signed in 2016, required all certified electronic health record (EHR) companies to implement the Fast Healthcare Interoperability Resources, an application programming interface (API) that allows for easier patient information transmissions across networks.
“Providers will have to use these APIs,” Outland said. “[The Office of the National Coordinator for Health Information Technology (ONC)] is working with the EHR vendors to be able to build this into their systems, and then be able to provide it to you as a clinician.”
ACP is continuing to work with ONC and CMS “to make sure the appropriate information is put into these APIs, and that you’re able to get the appropriate information to be able to manage your particular patient [and] your patient population as a whole,” Outland said.
Another administrative reform was the AMA’s updated CPT code set, which went into effect at the start of 2023. The update featured 225 new codes and 93 revisions and included changes affecting physicians who provide evaluation and management services. Inpatient and outpatient codes that were once separate are now represented in one set of codes, Outland said.
For physicians seeking to further increase their coding knowledge and experience, Outland recommended visiting the organization’s Coding for Clinicians resource.
“It goes through coding exercises, including how to do [hierarchical condition categories] coding,” he said.
References:
- AMA: New 2023 CPT code set includes burden-reducing revisions. https://www.ama-assn.org/press-center/press-releases/ama-new-2023-cpt-code-set-includes-burden-reducing-revisions. Published Sept. 9, 2022. Accessed May 25, 2023.
- Final 2023 Medicare physician fee schedule includes positive changes but confirms reimbursement cuts. https://www.acponline.org/advocacy/acp-advocate/archive/november-18-2022/final-2023-medicare-physician-fee-schedule-includes-positive-changes-but-confirms-reimbursement-cuts. Published Nov. 18, 2022. Accessed May 26, 2023.
- Medicare physician payment is NOT keeping up with inflation. https://www.ama-assn.org/system/files/medicare-updates-inflation-chart.pdf. Accessed May 26, 2023.
- Medicare physician payment is not keeping up with inflation. Why are physician services taking a backseat? https://www.ama-assn.org/sites/ama-assn.org/files/2022-09/medicare-updates-inflation-chart.jpg. Accessed May 26, 2023.
- 21st Century Cures Act. https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act. Accessed May 25, 2023.
- Outland B, et al. Ann Intern Med. 2022;doi:10.7326/M21-4484
- Outland B, et al. 60 Minutes: Special report on hot issues in health policy. Presented at: ACP Internal Medicine Meeting; April 27-29, 2023; San Diego.
