Nov. 17, 2023: Medicare Payment Reform Advocacy Update

The Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Physician Payment Schedule final rule. The 2024 Medicare conversion factor (CF) will be reduced by 3.37% from $33.8872 to $32.7442. Similarly, the anesthesia CF will be reduced from $21.1249 to $20.4349.

These cuts result from a -1.25% reduction in the temporary update to the CF under current law and a negative budget neutrality adjustment stemming in large part from the adoption of the new office visit add-on code. Unfortunately, these cuts coincide with ongoing growth in the cost to practice medicine as CMS projects a 4.6% Medicare Economic Index (MEI) increase for 2024. Physician practices cannot continue to absorb these increasing costs while their payment rates dwindle. Physicians urged (PDF) Congress to cancel the cuts and preserve access to care for Medicare beneficiaries.  

Despite comments from the AMA and others that the code is ambiguous and there is uncertainty about when to report it, CMS did not further reduce the utilization estimate or associated budget neutrality impact of the new evaluation and management add-on code, G2211, which was finalized in 2021 but then delayed for three years by Congress. Specifically, CMS maintained its estimate from the proposed rule that the add-on code will be reported with 38% of office visits in 2024.  

Additionally, CMS has postponed the implementation of updated MEI weights, which were finalized for CY 2023. The delay is in response to the need for continued public comment and the AMA's national study, the Physician Practice Information (PPI) Survey (PDF), to collect data on physician practice expenses. 

Notably, in response to organized medicine’s advocacy, CMS maintained the performance threshold to avoid a penalty in the Merit-based Incentive Payment System (MIPS) at 75 points in 2024. As a result, 78% of eligible clinicians are expected to avoid a MIPS penalty in 2026, a significant improvement from the CMS projection that just over half of eligible clinicians would avoid a penalty in the proposed rule. 

AMA staff have prepared a more detailed summary (PDF) and impact table (PDF) showing the estimated combined specialty impact of the final rule and -1.25% reduction of the temporary increase to the CF. 

More than three years after their initial adoption at the beginning of the COVID-19 pandemic, the final Medicare physician payment rule for 2024 has confirmed that the telehealth policies initially implemented in March 2020 will continue for nearly five years, at least through the end of 2024. This means that Medicare patients all over the country, not just those in rural areas, will continue to have access to telehealth services, and that patients will be able to engage in telehealth from their homes without having to travel to a medical facility to receive services from a distant site. Requirements for patients receiving telehealth for mental health conditions are also delayed through 2024. 

The telehealth policies in the final rule reflect AMA comments and recommendations in response to the proposed rule. All of the services that were on the Medicare telehealth list at the end of 2022 will continue to be covered when provided via telehealth through 2024, including the CPT codes for telephone visits. Physicians will be able to continue to provide direct supervision of nonphysician health professionals via real-time audiovisual interactive communications, and teaching physicians can supervise residents through real-time audiovisual interactive communications when the resident is providing a virtual service. Frequency limits on nursing facilities and inpatient hospital visits provided via telehealth have been lifted. 

The rule also indicates that CMS reviewed the comments it received from the AMA and other organizations asking the agency not to require physicians who provide telehealth services from locations other than their primary practice, such as their home, to report their home address on their Medicare enrollment. CMS has agreed not to impose such a requirement, but it may propose new policy on this issue in the future. 

CMS is also establishing permanent policy that payments for telehealth services provided to patients in their homes will continue to be paid at non-facility rates. 

Prior to CMS publicly reporting 2022 Merit-based Incentive Payment System (MIPS) data on Care Compare (formerly known as Physician Compare) or in the Provider Data Catalog (PDC), physicians and group practices can review and contest 2022 Quality Payment Program (QPP) performance information before it is posted live to the public. The preview period is open now and ends on Dec. 12 at 7:00 p.m. Central (8:00 p.m. ET/5:00 p.m. PT).  You can access the secure preview through the QPP website.  

Please refer to the resources below on how to preview your information: 

• Presentation: Preview Period: Performance Information for Doctors and Clinicians (Recording) (Slides, PDF) (Transcript, PDF)  
• Doctors and Clinicians Preview Period User Guide (PDF) 

For additional assistance with accessing the QPP website or obtaining your HCQIS Access Roles and Profile (HARP) user role, contact the QPP Service Center at [email protected]. You can also use the QPP Access User Guide (ZIP) to learn how to register with HARP. 

Please note that Accountable Care Organization (ACO)-level data is not available for viewing via the QPP site during the preview Period. MIPS-eligible clinicians who participate in Medicare Shared Savings Program ACOs can preview their performance information in their 2022 MIPS Performance Feedback. 

Shared Savings Program ACOs can also review quality performance information in their previously provided 2022 Quality Performance Reports. The list of ACO performance information planned for public reporting is available on the Care Compare: Doctors and Clinicians Initiative page. 

The recording for the latest webinar in the AMA’s Advocacy Insights series—“What’s next with Medicare payment reform”—is now available.  

Payment cuts and temporary fixes have become predictable in Medicare physician payment over the past decade—leaving physician practices and patient access to care at serious risk. We are working to change that by urging lawmakers to work with the physician community to permanently reform the system. Congress needs to establish a permanent, annual inflationary Medicare physician payment update that keeps up with the cost of practicing medicine and encourages practice innovation.  

Watch this AMA Advocacy Insights webinar to hear about: 

• Where Medicare payment reform stands now 
• How the AMA, alongside state and national medical specialty societies, is pushing for permanent payment reform 
• How you can get involved in these advocacy efforts 

Moderated by Willie Underwood III, MD, MSc, MPH, chair of the AMA Board of Trustees, speakers include: 

• G. Ray Callas, MD, president elect, Texas Medical Association 
• Katie Orrico, senior vice president, Health Policy and Advocacy, American Association of Neurological Surgeons/Congress of Neurological Surgeons 
• Todd Askew, senior vice president, Advocacy, American Medical Association 

View the recording and take action by visiting FixMedicareNow.org. 

• Nov. 17, 2023: Advocacy Update spotlight on the 2023 AMA Interim Meeting
• Nov. 17, 2023: National Advocacy Update
• Nov. 17, 2023: State Advocacy Update