New: AMA summary of 2025 Medicare Physician Payment Schedule proposed rule
On July 10, the Centers for Medicare & Medicaid Services (CMS) released the 2025 Medicare Physician Payment Schedule proposed rule. The 2025 Medicare conversion factor is proposed to decrease from $33.2875 to $32.3562. Similarly, the anesthesia conversion factor is proposed to be reduced from $20.7739 to $20.3340.
In a statement in response, AMA President Bruce A. Scott, MD, said, “[w]ith CMS estimating a fifth consecutive year of Medicare payment reductions—this time by 2.8 percent— it’s evident that Congress must solve this problem. In addition to the cut, CMS predicts that the Medicare Economic Index (MEI)—the measure of practice cost inflation—will increase by 3.6 percent. Facing this widening gap between what Medicare pays physicians and the cost of delivering quality care to patients, physicians are urging Congress to pass a reform package that would permanently strengthen Medicare.” Join the effort to safeguard access to care for Medicare beneficiaries by visiting FixMedicareNow.org.
In addition, CMS would maintain the Merit-based Incentive Payment System (MIPS) threshold to avoid a MIPS penalty at 75 points for the 2025 performance year. CMS proposes changes to telehealth policies, creation of G-codes and payment for new services spanning behavioral health to cardiovascular risk management, expansion of the transfer of care modifiers for all 90-day global surgical codes and payment for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection prevention at no cost-sharing. The AMA has prepared a summary (PDF) of the rule, along with an analysis (PDF) of CMS’ impact assumptions for proposed G-codes, the advanced primary care management services, and the proposed 90-day global surgical transfer of care policy. The AMA will continue analyzing the rule and will share draft comments with the Federation before the comment deadline of Sept. 9, 2024.
MIPS advocacy resources now available on Fix Medicare Now
Two new AMA advocacy resources are now available on the AMA’s Fix Medicare Now webpage. Both summarize information from the latest 2022 Quality Payment Program experience report (PDF). The first (PDF) includes several key takeaways from the report, including continued disproportionately low MIPS scores for small, rural and other types of practices, and notes how alternative payment model (APM) participation is at a critical inflection point with Qualifying APM Participant (QP) thresholds set to increase next year. The second (PDF) leverages 2022 data to demonstrate how AMA’s Data-driven Performance Payment System (DPPS) legislative solution would correct several persistent MIPS flaws by stabilizing Medicare physician payments, improving clinical reliability, and reducing reporting burden to stabilize patient access to medical services. The DPPS concept was informed by close collaboration with Federation partners.
More articles in this issue
- July 26, 2024: Advocacy Update spotlight on congressional action on Medicare physician payment
- July 26, 2024: National Advocacy Update
