Proposed Medicare Physician Fee Schedule includes payment cuts
The Centers for Medicare and Medicaid Services (CMS) released the 2023 Physician Fee Schedule (PFS) proposed rule, and medical associations are not happy with the proposed changes.
Namely, the 2023 plan would actually cut payments by 4.4%, as the proposed calendar year 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the 2022 PFS conversion factor of $34.61.
Physician services that are paid under the PFS are across a variety of 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. Suppliers for technical services are also paid under the PFS when institutional payments are not made. Medicare typically makes payments under a single rate for services, while PFS rates paid to physicians and other billing practitioners in facility settings reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. Diagnostic tests and some other services may have a separate payment under PFS, and the system bases payments on the relative resources typically used to furnish the service
The proposed rule solicits public comments on the policy changes, and stakeholders can leave public comments prior to the finalization of the PFS.
The proposed 2023 PFS was met with immediate criticism from the American Medical Association, which said it is still reviewing the proposed rule and will have more specific comments later. The proposed rule comes as healthcare providers have been stretched thin over the last two years dealing with the COVID-19 pandemic. From rising costs, personal protective equipment (PPE) shortages and a labor squeeze, healthcare institutions are still facing numerous challenges. A payment rate cut could further squeeze resources.
“It is immediately apparent that the rule not only fails to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also includes a significant and damaging across-the-board reduction in payment rates,” AMA President Jack Resneck, MD, said in a statement. “Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians. We will be working with Congress to prevent this harmful outcome.”
Other 2023 Proposed Changes
In addition to a payment rate cut, the 2023 PFS proposed rule also intends to make changes to Medicare telehealth services, “including making several services that are temporarily available as telehealth services for the public health emergency available through 2023, allowing more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list."
CMS proposes extending telehealth services coverage for a base period of 151 days after the public health emergency ends and also implement telehealth services in the Consolidated Appropriations Act, 2022 (CAA, 2022), which provided emergency assistance. The moves extend certain flexibilities in place after the PHE ends such as allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, allowing certain services to be furnished via audio-only telecommunications systems, and allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services.
The 2023 proposed rule also makes changes to behavioral health by allowing licensed professional counselors (LPCs), marriage and family therapists (LMFTs) and other types of behavioral health practitioners to provide behavioral health services under general (rather than direct) supervision. CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team, the agency stated.
Further, CMS wants to bundle certain chronic pain management and treatment services into new monthly payments, as well as cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.
“Integrated coordinated, whole-person care—which addresses physical health, behavioral health, and social determinants of health––is crucial for people with Medicare, especially those with complex needs,” said Meena Seshamani, PhD, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.
ACO Reform
In its current form, the 2023 PFS proposed rule makes significant changes to the Medicare Shared Savings Program (MSSP), specifically for accountable care organizations (ACOs), which are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated care.
The proposal is to incorporate advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs, based off CMS Innovation Center’s ACO Investment Model (AIM). The changes would mark the first time traditional Medicare dollars could be used to address Medicare beneficiaries’ social needs.
CMS also proposes giving smaller ACOs more time to transition to downside risk, which gives more opportunities to rural and underserved communities, the agency stated. Lastly, CMS wants to add a health equity adjustment to an ACO’s quality performance category score to reward excellent care delivered to underserved populations and benchmark adjustments to encourage more ACOs to participate and succeed.
See the unpublished proposed rule here.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."