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Unless Congress acts, physicians will face a 4.5 percent reduction in Medicare payments as of Jan. 1

Nov. 18, 2022 (ACP) — The 2023 Medicare Physician Fee Schedule final rule, released on Nov. 1, includes provisions that will make a positive difference for internal medicine physicians, including increases to payment rates for inpatient evaluation and management (E/M) services and changes to the Medicare Shared Savings Program (MSSP). However, publication of the final fee schedule also confirmed that unless Congress acts, physicians will face cuts to Medicare payments as of Jan. 1.

Once again, ACP is urging congressional leaders to act quickly to head off these cuts that are scheduled to go into effect on the first day of the new year. “These significant payment cuts must be prevented in order to ensure that medical practices are able to remain open, and physicians are able to work with Medicare beneficiaries,” said Dr. Ryan D. Mire, president of ACP.

The fee schedule lowers the conversion factor by 4.5 percent, as required by budget neutrality mandates required by law. “Ninety percent of medical practices reported that the projected reduction to 2023 Medicare payment would reduce access to care,” Anders Gilberg, a senior vice president with the Medical Group Management Association, said in a press release.

ACP has been a leading voice in opposition to these ongoing cuts. “Our grassroots advocacy is calling on Congress to act by not only providing immediate relief from a budget neutrality cut but also by adding on a Medicare Economic Index update, which is basically an inflationary update to the baseline of the fee schedule,” said Shari Erickson, ACP chief advocacy officer and senior vice president.

On the positive side, the Centers for Medicare and Medicaid Services is finalizing payment increases for inpatient E/M codes and aligning them with the recently updated outpatient E/M codes. ACP has long argued that E/M codes are undervalued and supported the increases made to the outpatient codes in 2021 that made progress in correcting this issue and addressing documentation burdens.

“This is a significant win,” Erickson said. “We were at the table in terms of rewriting the documentation requirements for these codes as well as helping to advocate for increased valuation.”

ACP is also pleased that CMS postponed until 2024 the implementation of changes to the “split” (or shared) E/M visits policy that would require physicians to bill only based on total time. However, ACP believes the delay should be longer, providing adequate time for the College and other stakeholders to inform policymaking that better accounts for the physician's contribution to those visits.

ACP is disappointed that the final fee schedule includes a provision that coverage for audio-only services will expire 151 days after the end of the COVID-19 public health emergency. “There are so many people in the country who don't have access to broadband. Or if they do have access to broadband, they may not have access to the technology to be able to access telehealth services,” Erickson explained. “Therefore, we are advocating for continued coverage of those audio-only services to ensure greater access to care.”

In addition, she noted, “we're advocating with Congress since CMS seems to feel they are limited in their statutory authority to be able to extend coverage of audio-only services.”

There is one more bit of good news: ACP is encouraged to see that CMS finalized changes in the MSSP that will address social drivers of health and help to improve health equity.

“We are especially encouraged by the health equity adjustment within the quality performance category, which begins to integrate health equity into aspects of the MSSP,” said Mire. “However, the College reiterates the importance of ensuring these efforts do not contribute to unnecessary administrative burden or unintended consequences. We are also happy to see that CMS finalized the Promoting Wellness MIPS [Merit-based Incentive Payment System] Value Pathway that is similar to a pathway on Preventive Care that ACP had previously suggested to CMS.”

Mire added: “ACP will continue to strongly advocate with Congress to prevent the scheduled payment cuts before the end of the year and ensure stability in physician payments. We will also continue to work with CMS and other stakeholders to tackle the concerns we have for next year's fee schedule and to work toward a better payment system.”

Back to the November 18, 2022 issue of ACP Advocate