Sept. 22, 2023: Medicare Payment Reform Advocacy Update

In a detailed, 120-page comment letter to the Centers for Medicare & Medicaid Services (CMS) (PDF) regarding proposed Medicare fee schedule policies for 2024, the AMA underscored concerns regarding ongoing conversion factor reductions, specifically the proposed 3.36% reduction in the 2024 Medicare conversion factor (CF) and corresponding reduction in anesthesia CF rates.

Over the period of 2001 to 2023, Medicare physician payment rates have plummeted by 26% when adjusted for inflation, which is only projected to worsen next year. CMS estimates that the cost to practice medicine as measured by the government’s Medicare Economic Index (MEI) will be 4.5% in 2024. The growing discrepancy between what it costs to run a medical practice and what physicians are paid poses a serious threat to the stability and vitality of physician practices across the nation—and jeopardizes access to care, particularly for smaller physician practices and in underserved areas.  

The proposed payment reductions are attributable to two factors, including a -1.25% reduction stemming from a temporary update enacted in legislation and a negative budget neutrality adjustment linked to the introduction of a CMS-developed office visit add-on code. While the AMA greatly appreciates CMS’ efforts to reassess the utilization assumption of the office visit add-on code, the AMA is also strongly urging the agency to further refine and reduce its projected utilization assumption to prevent unwarranted reductions in the Medicare conversion factor. The lack of clarity surrounding the appropriate circumstances for reporting this code, combined with potential implications for patient cost-sharing, has created significant ambiguity among health care practitioners.

The AMA is also urging Congress to pass legislation that would provide annual, inflation-based updates to counteract the diminishing value of Medicare physician payment and allow physician practices to invest in new technology and staff to assure Medicare beneficiaries have access to high-quality care.  

In addition, the AMA made the following comments

• The AMA thanks CMS for postponing the implementation of updated MEI weights and for acknowledging the AMA’s current survey (PDF) to collect practice cost data from physician practices. 
• The AMA supports CMS' proposals to continue paying for telehealth services provided nationwide and to patients in their homes, as well as the continuation of payment for all Medicare telehealth services covered in 2022 through the end of 2024. 
• The AMA supports CMS' proposal to pause the implementation of the AUC Program and to rescind current program regulations until the necessary program modifications can be made. 
• Regarding the Medicare Shared Savings Program (MSSP), the AMA applauds CMS’ proposals to postpone the transition to electronic clinical quality measures due to logistical considerations. However, the AMA opposes proposals that would counteract CMS' objective of encouraging more physicians to shift to alternative payment models, such as CMS' proposal to mandate that all MSSP participating clinicians, regardless of their track, report the Merit-based Incentive Payment System (MIPS) Promoting Interoperability measures. 
• The AMA strongly recommends that CMS take steps to alleviate the burden on MIPS eligible physicians during the 2024 performance period and at a minimum, CMS should maintain the current performance threshold at 75 points to prevent undue penalties. 

On Aug. 10, CMS made available 2022 MIPS performance feedback, which determines whether physicians will receive a positive, neutral or negative payment adjustment on Medicare services furnished in 2024. The AMA has heard alarming reports of physicians facing MIPS penalties in 2024 for the first time since the program started. We strongly encourage you to view this information as soon as possible for two reasons:

1. If there are any errors, you should consider submitting an appeal, also called a targeted review. For more information about how to request a targeted review, please refer to the 2022 Targeted Review User Guide (PDF). The deadline to submit a targeted review is Oct. 9, 2023.
2. You can help us advocate against Medicare physician payment cuts in 2024 by sharing this information. If you feel comfortable, you can share de-identified score and corresponding payment adjustment information. This will inform our understanding of the impact of MIPS on physician payment in 2024 and can help us in our conversations with the administration and Congress about ensuring physician payment supports high-quality care to Medicare patients. Please share your information by emailing the AMA Advocacy staff at [email protected].

Physicians can view their 2022 MIPS Performance Feedback information on the Quality Payment Program (QPP) website using their HCQIS Access Role and Profile (HARP) credentials. The CMS Payment Adjustment User Guide (PDF) walks through the process of accessing and downloading performance feedback.

In a letter (PDF) to CMS, the AMA strongly urged the agency to improve the frequency and usefulness of the MIPS data shared with physicians and to resolve discrepancies in the MIPS public use files. Though Congress took action to give physicians access to their data, they still do not receive timely, actionable feedback in Medicare. In addition, the aggregate program-level information about MIPS that has been made publicly available is incomplete and inconsistent. The AMA recommended that CMS take the following steps to remedy these problems: 

1. Make Medicare claims data and meaningful MIPS attribution, measure and performance data available on a rolling basis or, at a minimum, on a quarterly basis during the actual performance period. 
2. Explain and correct inconsistencies between MIPS public data files, particularly regarding why so many national provider identifiers (NPIs) are missing from the National Downloadable File, and instruct physicians how to otherwise access this important data. 
3. Clarify the number of unique clinicians participating in MIPS in future Quality Payment Program (QPP) Experience Reports and include a breakdown of the different scores unique clinicians receive through multiple groups or Alternative Payment Models (APMs). 
4. Provide detailed information in the QPP Experience Report about performance by specialty, region, site of service and participation option. These reports should also display longitudinal trends about whether quality or cost is improving or declining and provide a more complete picture of what makes a physician, group practice or APM successful in MIPS. 

• Sept. 22, 2023: National Advocacy Update
• Sept. 22, 2023: State Advocacy Update