Industry Reactions to Proposed Rule

CMS released the 2023 Medicare Physician Fee Schedule and Quality Payment Program (QPP) proposed rule on July 7. This proposed rule included updates to payment rates for physicians and other health care professionals, extended telehealth waivers and flexibilities, adopted evaluation and management (E/M) coding changes, made significant changes to the Shared Savings Program, revised policies for the 2023 performance year of the QPP, and included many other provisions. Comment period is open until September 7.

Here are some preliminary reactions and comments from around the industry.

AMA: Medicare payment schedule rule threatens patient access
The following statement is attributable to:
Jack Resneck Jr., M.D., President, American Medical Association

“The American Medical Association (AMA) is reviewing the Medicare payment schedule and will have detailed comments later. 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. 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.

“The AMA and our partners in organized medicine have developed a set of principles (PDF) to guide advocacy efforts on Medicare physician payment reform. This is part of the AMA’s Recovery Plan for America’s Physicians and represents our ongoing work to establish a rational Medicare physician payment system that provides financial stability through positive annual payment updates, improves the financial viability of physician practices, and eases administrative burdens.

MGMA statement on CMS’ proposed 2023 Medicare Physician Fee Schedule
By Anders Gilberg, Senior Vice President, Government Affairs, Medical Group Management Association

“Having reviewed the proposed 2023 Medicare Physician Fee Schedule, MGMA is incredibly concerned about the likely impact of the proposed 4.42% reduction to the conversion factor, especially in light of the financial uncertainty which medical groups have faced over the past two years stemming from the COVID-19 pandemic, inflation, and the staffing crisis. These proposed cuts, coupled with the 4% PAYGO sequestration scheduled to take effect on Jan. 1, 2023, will have a detrimental impact on group practices, with 58% of recently surveyed groups indicating they are considering limiting the number of new Medicare beneficiaries served should the cuts take effect. MGMA appreciates the continued efforts from CMS to ensure cohesion of post-pandemic policies for medical group practices. The extension of regulatory Medicare telehealth flexibilities to align with the 151 days of congressionally extended telehealth policies will ensure practices have the ability to continue furnishing the highest quality care to patients.”

AHCA/NCAL Issues Statement On Members Of Congress Expressing Concerns Over Proposed Payment Cuts For Nursing Homes
The following statement is attributable to AHCA/NCAL president and CEO Mark Parkinson:

“We thank Senator Tester and Congressman Correa for their leadership in advocating on behalf of our nation’s seniors. We agree that cutting millions in nursing home funding will put access to care for our most vulnerable citizens at risk. The COVID-19 pandemic has led to an unprecedented workforce shortage and economic crisis within the long term and post-acute care sector. Sixty percent of nursing homes say their workforce situation has worsened since January, and more than half say they cannot sustain their current operating pace for more than one year.

“We believe the Medicare parity adjustment should be phased in over multiple years – not during a time when our industry continues to face these historic challenges. Hundreds of nursing homes across the country have already been forced to permanently close their doors, and the proposed Medicare cuts will put even more facilities in jeopardy of shutting down and displace thousands of seniors. We look forward to working with the Biden administration and Members of Congress to ensure vulnerable seniors have access to the care they need.”

2023 Proposed Medicare Physician Fee Schedule Reaffirms Need for Congress to Fix Physician Payment Methodology
Statement attributable to:
Sterling Ransone, Jr., MD, President, American Academy of Family Physicians

“The American Academy of Family Physicians (AAFP) is concerned that the Centers for Medicare and Medicaid Services’ (CMS) 2023 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) proposed rule may result in untenable Medicare payment cuts for family physicians in 2023 and jeopardize patients’ timely access to essential primary care. Federal Medicare physician payment laws prevent our nation from making vital investments in primary care. The AAFP calls on CMS and Congress to address these limitations amid rising practice costs and an ongoing public health crisis.

New Medicare Fee Schedule Rule Further Illustrates a Broken Payment System

The American Society of Anesthesiologists (ASA) announced its opposition to additional Medicare payment cuts included in the Centers for Medicare & Medicaid Services’ (CMS) 2023 Physician Fee Schedule (PFS). Within the fee schedule, CMS proposed Medicare payment cuts to the Anesthesia Conversion Factor and in revised injection codes where imaging is now bundled – reductions that compound the financial strain anesthesia groups are already facing.

Anesthesiologists and other pain medicine physicians have historically been unduly impacted by year-over-year Medicare payment cuts. This trend exacerbates unfair payment policies, as Medicare payment rates for anesthesia services persistently hover around 33% of average commercial insurance company rates, far lower than Medicare payment rates for other specialties, which average 80% of commercial insurance rates. Anesthesiologists receive payment from Medicare at a tiny fraction of the cost of providing that care.

AAMC, Provider Groups Urge Congress to Act on Physician Payment Cuts

The AAMC joined other provider groups in a July 27 letter to key congressional committee leaders urging them to take legislative action to avoid an expected 8.5% cut to physician payments in the Medicare program.

The letter to Senate Finance Committee Chair Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho), House Ways and Means Committee Chair Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas), and House Energy and Commerce Committee Chair Frank Pallone (D-N.J.) and Ranking Member Cathy McMorris Rodgers (R-Wash.) thanked the leaders for their action to avert Medicare physician payment cuts through the Protecting Medicare and American Farmers from Sequester Cuts Act (P.L. 117-22) [refer to Washington Highlights, Dec. 10, 2021]. It notes, however, that while the payment reduction relief policies provided through that law have temporarily stabilized physician payment, additional reductions to Medicare physician payments are impending.

Patient care under continued threat in proposed Medicare Physician Fee Schedule

The proposed Medicare Physician Fee Schedule for calendar year 2023 (CY2023) released by the Centers for Medicare & Medicaid Services (CMS) once again jeopardizes seniors’ access to critical treatments and procedures, according to the Surgical Care Coalition.

CMS is proposing to cut the Medicare conversion factor—the basic starting point for calculating Medicare payments—by 4.42% for CY2023. As surgical care faces another round of proposed cuts, it’s clear that these cuts on top of the sequester cuts threaten patient care and are unsustainable for the long term. Congress must take action to stop another round of cuts, while also stabilizing the system, to protect patients and the care they need.

National Association of ACOs (NAACOS) President and CEO Clif Gaus, Sc.D., issued the following statement on the Centers for Medicare & Medicaid Services’ Proposed 2023 Medicare Physician Fee Schedule:

“NAACOS sends a big bravo to the Centers for Medicare and Medicaid Services (CMS) for taking steps to reach its goal of creating a stronger Medicare by strengthening accountable care models and speed the movement toward value for all patients. While we are still studying the major changes, policies in today’s proposed Physician Fee Schedule will help grow participation in accountable care organizations (ACOs), helping realize the CMS Innovation Center’s recent Strategy Refresh to have every Medicare beneficiary in a relationship with a provider accountable for his or her quality and total cost of care by 2030.