Medicare Payment Rule Released with Yet Another Payment Cut That Must Be Fought
With the proposed 2024 Medicare Physician Payment rule calling for a 3.36% cut to the Medicare conversion factor, I encourage you and your physician colleagues to contact your Representative and Senators Schumer and Gillibrand to urge that they enact legislation (HR 2474) that would instead provide annual positive updates in Medicare payment.
For more information about the 2024 rule, please see the CMS Fact sheet and Quality Program Changes . As reported by the AMA, the other notable Medicare proposals for 2024 include:
- A reduction in the anesthesia conversion factor from $21.1249 to $20.4370. These cuts result from a reduction in the temporary update to the conversion factor under current law and a negative budget neutrality adjustment, stemming in large part from the adoption of an office visit add-on code.
- A mitigation in the anticipated cuts due to the budget neutrality impact of adding the new evaluation and management (E/M) add-on code, G2211, which was finalized in 2021 but then delayed for three years by Congress. Specifically, CMS has lowered the estimated utilization assumption of the add-on code from 90% in its 2021 rule to 38% when initially implemented in 2024 and 54% once the code has been fully adopted.
- Continued postponement of the implementation of the updated MEI weights, referencing the AMA’s national study to collect representative data on physician practice expenses, the AMA Physician Practice Information (PPI) Survey. The PPI Survey launches on July 31st, and data is anticipated to be shared with CMS in early 2025. In last year’s Final Rule, CMS finalized updated MEI weights for the different cost components of the MEI for CY 2023. However, CMS also noted that they postponed implementation of the MEI changes, referencing the need for continued public comment due to the significant impact to physician payments. If the implementation of the MEI weights was budget neutral, overall physician work payment would be cut by 7% and PLI payment would be reduced severalfold.
- Increasing the performance threshold to avoid a penalty in the Merit-based Incentive Payment System (MIPS) from 75 points to 82 points. CMS estimates this would result in an increase in the number of MIPS eligible clinicians who would receive a penalty of up to –9%. The AMA indicated that it will strongly oppose increasing the threshold and is alarmed that CMS would propose an increase that results in a significant increase in physicians being penalized by MIPS, as the program has been largely paused since 2019 due to the significant disruptions caused by the COVID-19 pandemic.
