Medicare’s Proposed Physician Fee Schedule a Mixed Bag, Doc Groups Say

WASHINGTON — Doctor group responses to the proposed 2023 Medicare Doctor Price Schedule ranged from disappointment over the proposed 4.4% total fee lower to reward for lots of the provisions associated to accountable care organizations (ACOs).
“The scary half for many of us is we’re getting these reductions even though we’re nonetheless combating the pandemic and regardless of the very fact we now have a comparatively giant inflation price,” Sterling Ransone Jr., MD, president of the American Academy of Household Physicians, stated in a cellphone interview. “Seeing 9% inflation for the products and providers we now have to pay for, whereas [also having] a 4.4% discount in what we’re being paid, is frightening.”
The 4.4% decrease CMS proposed features a lower within the conversion issue, a multiplier used to calculate doctor reimbursement for fee-for-service funds below Medicare. The proposed conversion issue for the 2023 Doctor Price Schedule rule is $33.08, a lower of $1.53 from final yr, in accordance with a CMS fact sheet. The proposed conversion issue accounts for the statutorily required replace of 0%, the expiration of a 3% enhance in doctor funds required by Congress, and the required funds neutrality adjustment to account for modifications in relative worth models, CMS stated.
The full Doctor Price Schedule lower can be on high of a 4% Medicare “pay-as-you-go,” or PAYGO lower — delayed from final yr — that’s scheduled to take impact in January 2023.
Hoping for Assist From Congress
Brian Outland, director of regulatory affairs on the American Faculty of Physicians, famous that Congress had beforehand handed a 3% enhance within the conversion issue “however that 3% didn’t transpire over to Medicare as of but. We’re hoping Congress will act earlier than January 1 so as to add that cash again into the charge schedule.”
Telehealth was one other space of concern for Outland. Though CMS has a waiver to proceed its present fee schedule for telehealth visits for 150 days after the COVID-19 public well being emergency ends, the waiver does not apply to audio-only visits. that are the one sort of telehealth utilized by some seniors who usually are not tech-savvy. The proposed charge schedule did not point out any motion can be taken on that concern, he stated.
One other concern in regards to the charge schedule, significantly for the surgical procedure neighborhood, is that CMS shouldn’t be correctly valuing the analysis and administration visits that surgeons present for his or her surgical sufferers through the “international” reimbursement interval for surgical procedure, John Ratliff, MD, chair of the Washington committee of the American Affiliation of Neurological Surgeon/Congress of Neurological Surgeons, stated in a cellphone interview. “The non-surgeon is getting extra reimbursement for the follow-up go to than a proceduralist would for a similar work being completed through the international interval” by which a surgeon will get a single flat charge it doesn’t matter what providers are offered.
“That is establishing a two-tiered system of doctor reimbursement, that means I see a affected person within the outpatient clinic for, say, a Stage 3 follow-up go to they usually have not had surgical procedure, then I receives a commission one worth. But when I am doing a comparable quantity of labor and spending a comparable period of time on a affected person I’ve not too long ago completed surgical procedure on, the analysis of these providers are completely different, as a result of one is within the international interval and one is not,” Ratliff stated. The American Faculty of Surgeons and different surgical procedure organizations, he stated, “requested CMS to think about correcting this imbalance inside the charge schedule, however CMS has constantly refused that, and it is one other problem America’s training physicians face in making an attempt to attain acceptable reimbursement for the work we’re doing.”
Good Information for Would-Be ACOs
However, the proposed charge schedule additionally incorporates a number of provisions geared toward encouraging extra physicians to type ACOs.
As an illustration, within the Medicare Shared Financial savings program, the charge schedule would “enable eligible ACOs to obtain a one-time fastened fee of $250,000 and quarterly funds for the primary 2 years of their 5-year settlement interval,” healthcare attorneys with the legislation agency Morgan Lewis said in a blog post. “Quarterly funds can be decided utilizing a 100-point scoring methodology, which might pay larger quantities to ACOs serving excessive numbers of twin eligible beneficiaries or these residing in areas of excessive deprivation … with the aim that such elevated funding can be used to handle the beneficiaries’ social and different well being wants.”
The company would recoup these superior funds as soon as the ACO begins to indicate shared financial savings, but when it does not accrue financial savings, CMS would not recoup any funds until the ACO will get out of this system through the settlement interval, in accordance with the weblog put up. ACOs might begin making use of for the advance funding subsequent yr, with a goal begin date of Jan. 1, 2024.
Such provisions are very welcome, Susan Dentzer, president and CEO of America’s Doctor Teams, a corporation for physician-led ACOs, stated in a cellphone interview. “Having the superior incentive funds up-front going to be extraordinarily useful in getting lot of smaller practices into this system quickly,” she stated.
CMS additionally proposes to provide ACOs extra time in applications which can be solely “upside threat” — they obtain a reimbursement in the event that they present financial savings in contrast with conventional Medicare, however they do not must pay any cash if they do not produce financial savings — earlier than they’re required to simply accept draw back threat as properly, Dentzer added. “It is mainly main encouragement for smaller practices to get into [these arrangements], and that can clearly result in formation of ACOs in elements of nation the place they have not had a lot of a job.”
“Given the targets of getting everyone [now] in conventional Medicare into an ACO by 2030, they must push on an entire bunch of levers in value-based care. So the entire new strategy they borrowed from different experiments prior to now” may be very constructive, Dentzer stated.
Updating Pricing Knowledge
America’s Doctor Teams additionally was happy with modifications CMS is proposing to ACO efficiency benchmarks, Garrett Eberhardt, the group’s director of federal affairs, stated on the identical cellphone name. “We’re very happy they’re making an attempt to make some accounting for incontrovertible fact that ACOs usually have their benchmark [negatively] affected by among the prior financial savings they accrued,” he stated.
The American Academy of Household Physicians’ Ransone additionally lauded CMS’s proposal to replace the info utilized in its scientific labor pricing, which is a part of its calculation of Medicare fee charges. “Final yr we discovered that [their data] from the Bureau of Labor Statistics was from 2002, so it was 20 years previous,” Ransone stated. In his personal follow, “we pay our RNs about 60% greater than in 2002, and our medical assistants 40% extra,” he stated. “We’re completely satisfied they will replace [those data] so we will proceed to pay our workers what they deserve,” significantly at a time when many suppliers have seen workers members go away for different jobs, akin to journey nursing, that pay a lot greater charges.

Joyce Frieden oversees MedPage Right now’s Washington protection, together with tales about Congress, the White Home, the Supreme Court docket, healthcare commerce associations, and federal businesses. She has 35 years of expertise masking well being coverage. Follow