The Centers for Medicare & Medicaid Services (CMS) released its final physician fee schedule rules on November 1, intended to go into effect on January 1, 2023. But the ruling continues to see pushback from provider groups and congressional advocates.
The CMS Cuts are Deep
Time is of the essence for doctors desperately trying to avoid the 4.5 percent decrease in Medicare reimbursement, while hospitals are seeking to prevent the 4 percent cut to their Medicare payments. CMS bases its reimbursement rates on a conversion factor per RVU (Relative Value Unit). Despite the persistent inflation in the United States, Medicare Conversion Factors have remained consistent for over two decades.
The decrease in payments will put a tremendous financial strain on physicians, creating the need to make hard decisions such as shuttering their practice or becoming employed by a hospital. The implications for patients who depend on these physicians would be catastrophic, and the impact would be far-reaching.
Can a Bipartisan Act of Preservation Save APMs?
On December 14, Senator John Barrasso (R-Wyo.) and U.S. Senator Sheldon Whitehouse (D-R.I.) introduced a new bill, the Preserving Access to Value Based Care Act. This legislation, supported by both political parties, strives to ensure that healthcare providers participating in Medicare hold fast to their dedication to Alternative Payment Models (APMs), which are based on value-driven models.
Rather than rewarding providers for the sheer quantity of services they offer, the program incentivizes them to deliver top-notch care through reimbursements. Time and again, physicians involved in APMs have attested that value-based care yields a superior quality of care.
The bill proposes maintaining the five percent advanced APM incentive payment for providers for the next two years. In addition, the bill guarantees that the eligibility requirements for participating practices in Medicare’s advanced APMs remain within reach. It would also keep the existing 50 percent advanced alternative payment model revenue threshold, encouraging providers to transition to value-based care.
Calls to Stop the CMS Cuts Stem from the Inside
In September, the National Association of ACOs wrote a letter that ardently called upon Congressional leaders to prolong incentive payments. Numerous physicians, healthcare associations, and provider care organizations signed the letter.
The groups say incentive payments have provided much-needed resources for various programs, such as wellness initiatives, patient transportation, and meal services. Additionally, it enables beneficiaries to share costs and employ care coordinators.
If Congress chooses not to extend the incentive-based payment, it will cease to exist at the end of 2022. This could push providers away from accepting Medicare patients, as their financial resources are already strained.
Veritas Experts encourages physicians and patients to urge congress to halt the planned cuts and support the Preserving Access to Value Based Care Act.
Everyone deserves access to high-quality care. Without our trusted physicians and these supports, we all suffer.