The Centers for Medicare & Medicaid Services (CMS) dropped a bombshell in July: they released their proposed rule for next year’s Medicare physician fee schedule.
The big news? They’re planning to slash physician payment rates by 2.8%! Industry groups are already up in arms, insisting that physician reimbursement needs to keep pace with inflation.
Here’s what this means: the conversion factor, which determines how much doctors get paid for treating Medicare patients, would drop from $33.29 this year to $32.36 in 2025. Buckle up, because this proposal is sure to spark some heated debates!
Read the full press release here.
In a statement, CMS Administrator Chiquita Brooks-LaSure explained “The Biden-Harris Administration is committed to protecting and expanding Americans’ access to quality, affordable health care.” She added “the Calendar Year 2025 Physician Fee Schedule proposed rule supports physicians and other practitioners in delivering care that meets the needs of people with Medicare, including through telehealth flexibilities, strengthened primary, behavioral, and oral health care, and improved access to caregiver training services.”
Several industry groups released statements protesting the rule, including:
- The American Medical Association (AMA)
- Premier
- Medical Group Management Association (MGMA)
- American Academy of Family Physicians (AAFP)
- National Association of Accountable Care Organizations (NAACOS)
- Society for Cardiovascular Angiography & Interventions (SCAI)
“The death by a thousand cuts continues,” said AMA President Bruce A. Scott, MD. “Rural physicians and those treating underserved populations see this CMS warning as another reminder of the painful challenges they face in keeping their practices open and providing care. It’s crucial that we ensure both continue.”
But it’s not all about cuts. Here are other highlights from the proposed rule.
Boosting Behavioral Health Services
CMS is also proposing several measures to improve payment and access to behavioral health services. This includes expanding payments for opioid treatment programs, especially for new FDA-approved overdose reversal medications. They’re also looking to extend telehealth flexibility for these programs.
Extending Telehealth Waivers
Telehealth users, rejoice! CMS wants to keep certain telehealth waivers through 2025. This means you can continue reporting your practice address instead of your home address when working from home. Federally qualified health centers and rural health clinics can keep billing for telehealth services. Plus, virtual supervision for residents in all teaching settings would continue.
Updates to the Quality Payment Program
For those involved in the Quality Payment Program, CMS is suggesting six new, optional Merit-based Incentive Payment System Value Pathways (MVPs) starting in 2025. They’re also seeking feedback on potentially making MVP participation mandatory from 2029 onward.
Changes to the Medicare Shared Savings Program
CMS is also making moves with the Medicare Shared Savings Program. They want to mitigate the impact of significant, anomalous, and highly suspect (SAHS) billing activity by excluding these payment amounts from financial calculations for the relevant year and from historical benchmarks.
Have Your Say!
Want to weigh in? CMS is accepting comments on the proposed rule through September 9th. Contact Legacy Consulting Services today to help you navigate these changes and protect your bottom line. Our expertise can guide you through the complexities of the proposal and potential payment cuts, ensuring you stay ahead of the curve.