Medical groups push for end to yearly payment cuts

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The Centers for Medicare and Medicaid Services has finalized the proposed 2.8% payment cut for physicians in its 2025 Medicare Physician Fee Schedule final rule.

Medical groups swiftly protested and said something must be done now to avert the cut before the end of this year's legislative session, and said a permanent solution is needed to prevent the annual congressional intervention.

Dr. Bruce A. Scott, president of the American Medical Association, said, "In the 3,088 pages and thousands of statistics included in the final rule of the 2025 Medicare physician fee schedule released today, there are two numbers that stand out: 2.8 and 3.5. The 2.8 is the percent payment cut for physicians that is scheduled to take place next year. The 3.5 is the estimated percent rise in the Medicare Economic Index, which is the government's measure to gauge increases in the costs of physicians delivering care to our Medicare patients. To put it bluntly, Medicare plans to pay us less while costs go up. You don't have to be an economist to know that is an unsustainable trend, though one that has been going on for decades."

American Academy of Family Physicians president Dr. Jen Brull said, "Inadequate Medicare payment rates have created untenable barriers to care for patients and threaten physician practices. While the final 2025 Medicare physician fee schedule aims to strengthen primary care, the underlying deterioration of physician payments negates the impact of these important investments. Sadly, this is the fifth year in a row congressional intervention will be needed to preserve payment."

MGMA SVP of Government Affairs Anders Gilberg said, "CMS and Congress have once again overlooked the sobering financial realities facing our nation's medical practices, finalizing a 2.83% reduction to the 2025 Medicare conversion factor, further increasing the gap between practice expenses and reimbursement rates."

Dr. Howard M. Sandler, chair of the ASTRO board of directors, said, "The final 2025 Medicare Physician Fee Schedule continues to erode reimbursement rates for radiation therapy, further diminishing access to essential cancer treatments for Medicare beneficiaries."

CMS said in accordance with update factors specified by law, finalized average payment rates under the PFS will be reduced by 2.93% in CY 2025 compared to the average payment rates for most of CY 2024. The change to the PFS conversion factor reflects the 0% update required by statute for 2025, the expiration of the 2.93% temporary increase in payment amounts for 2024 required by statute, and a small budget neutrality adjustment necessary to account for changes in valuation for particular services.

This amounts to a finalized 2025 PFS conversion factor of $32.35, a decrease of $0.94 (or 2.83%) from the current CY 2024 conversion factor of $33.29.

WHY THIS MATTERS

A bipartisan bill introduced in the House last week would stop Medicare payment cuts from going into effect in 2025. The Medicare Patient Access and Practice Stabilization Act would provide a 4.7% payment update in 2025 and eliminate the 2.8% Medicare physician payment cut that is slated for January 1. 

"Now there are only a precious few legislative days left," the AMA said. "Unless Congress acts during the lame duck, the cuts will go through. Physicians and patients are watching, wondering if Congress is up to the task of fixing this broken reimbursement system. Thankfully, there are signs that lawmakers recognize the gravity of the situation."

The AMA said it wants the administration to work with Congress to enact a permanent, annual inflation-based update to Medicare physician payments. 

THE LARGER TREND

Provider groups were pleased with other aspects of the final rule having to do with telehealth, MIPS, coding and more.

Premier said it was pleased that CMS finalized the new Advanced Primary Care Management codes for 2025, saying they are an important step toward achieving hybrid primary care payment within the framework of traditional Medicare. 

Telehealth flexibilities related to payment are scheduled to expire at the end of the year. CMS has limited authority to preserve the telehealth flexibilities that were enacted during COVID-19 and then extended.

"Through today's final rule, CMS is continuing to permit certain practitioners to provide direct supervision via a virtual presence of auxiliary personnel, when required, virtually through immediate availability via real-time, audio-video technology. CMS is also finalizing temporary extensions to allow teaching physicians to be present virtually when they furnish telehealth services involving residents in teaching settings," CMS said.

Absent Congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the public health emergency will again be in effect for most telehealth services. These include geographic and location restrictions and limitations on the scope of practitioners who can provide Medicare telehealth services. 

If Congress fails to act, people with Medicare generally will need to be located in a medical facility in a rural area to receive most Medicare telehealth services, with a notable exception for behavioral health telehealth services which can continue to be provided in the patient's home, according to CMS.

CMS said it is continuing steps to further strengthen the Medicare Shared Savings Program. For the first time, CMS will allow eligible ACOs with a history of success in the program to receive an advance on their earned shared savings. 

Aisha Pittman, senior vice president of Government Affairs of the National Association of ACOs said, "The National Association of ACOs (NAACOS) commends CMS for its ongoing efforts to support ACOs by finalizing policies that protect against significant and unusual billing anomalies, thus fostering long-term stability and certainty for ACOs."

CMS is finalizing the addition of six new MIPS Value Pathways under the CMS Quality Payment Program's Merit-based Incentive Payment System (MIPS). These pathways address ophthalmology, dermatology, gastroenterology, pulmonology, urology and surgical care.

APTQI, the Alliance for Physical Therapy Quality and Innovation, applauded the rule's expansion of general supervision for physical therapy assistants and occupational therapy assistants, which reduces administrative burden. The organization also praised CMS for finalizing a provision that provides an exception to the physician/nonphysician practitioner signature requirement on the therapist-established plan of care for purposes of the initial certification. 

Email the writer: SMorse@himss.org