“The Medicare payment schedule released today puts Congress on notice that a nearly 4.5% across-the-board reduction in payment rates is an ominous reality unless lawmakers act before Jan. 1”
Providers face ‘ominous reality’ of payment cuts as CMS finalizes 2023 Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) has published its final rule for the 2023 Physician Fee Schedule (PFS).
The PFS dictates what Medicare pays for the services of physicians and other billing professionals across settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories and beneficiaries’ homes.
For 2023, physicians are now bracing for a payment cut, after the final rule stripped the 3% supplemental increase to PFS payments for calendar year 2022. The final 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the 2022 PFS conversion factor of $34.61, CMS published Nov. 1.
Industry groups were up in arms about the cuts in the final rule, voicing their concerns about the fallout to providers and patients, as well as access to care.
“As expected, CMS finalized a substantial reduction to the conversion factor—negatively impacting physician reimbursement across the board,” Medical Group Management Association (MGMA) Senior Vice President Government Affairs Anders Gilberg said in a statement. “It is more critical than ever that Congress act to avert these cuts, as well as the 4% PAYGO sequestration, before the end of the year. Ninety percent of medical practices reported that the projected reduction to 2023 Medicare payment would reduce access to care.”
“The Medicare payment schedule released today puts Congress on notice that a nearly 4.5[%] across-the-board reduction in payment rates is an ominous reality unless lawmakers act before Jan. 1,” said Jack Resneck, Jr., MD, president of the American Medical Association (AMA). “The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians.”
Both AMA and MGMA commented on the rule for the proposed 2023 PFS schedule when it came out earlier this year, urging CMS to avoid payment cuts as hospitals and health systems are facing some of the biggest financial struggles to date. Industry groups are also urging Congress to intervene before the end of the year to avoid the payment cuts.
“This cannot wait until next Congress—there are claims processing implications for retroactively applying these policies,” Gilberg said. “MGMA looks forward to working with both Congress and the Administration to mitigate these cuts and develop sustainable payment policies to allow physician practices to focus on treating patients instead of scrambling to keep their doors open.”
In addition to publishing the payment cuts, CMS also finalized expanded access to behavioral healthcare through a whole-person approach and solidified telehealth payment benefits.
See the final rule here.
FROM TEXAS PHYSICIAN
I’ve seen this movie many times before. Congress always comes to the “rescue” late in the game……after they’ve extracted political contributions from all the physician constituencies. The problem is that the government bureaucrats (and congress people) have thought physicians have been getting paid too much for 20-25 years. They came to this conclusion back in the ‘90’s and began a process of ratcheting down the fees they pay, a little bit every year. While the cost of operating a practice (malpractice, operating expenses, etc) have gone up by some 80% since then, the Medicare reimbursement rate has gone up maybe 20% (that’s just an estimate of the disparity – I know it’s huge!!). The Texas Medical Association has a great chart that shows how this has been working over that time.
So, the bureaucrats can continue to think physicians are paid too much (there are a few specialties where that is the case), but it’s gotten to the point where it isn’t worth going into high risk specialties anymore. So, as the baby boomers retire (you’re one of those!), who is going to replace your hip, perform CABG’s on you and take care of your head trauma when you fall at home? I guess you might get some guy from India or Venezuela or Cuba who will do it for less, but then what is the cost of the diminution in the quality of care.
We are rapidly heading in that direction now. I’m just trying to hang on so I have as much quality care as I can get while I can still get it. I see it slipping away.