CMS advances 2024 physician fee schedule, health equity agenda: Industry reacts
Hospital outpatient departments are in line for a Medicare rate increase in 2024, but program payments for doctors could decline, according to proposed new policies from the Centers for Medicare and Medicaid Services.
The Centers for Medicare & Medicaid Services last week proposed increasing payments for hospital outpatient services by 2.8%, or about $6 billion. In a separate proposal, it recommended a 1.25% pay decrease for doctors, although rates for some primary services would go up.
“At CMS, our mission is to expand access to health care and ensure that health coverage is meaningful to the people we serve,” CMS Administrator Chiquita Brooks-LaSure said. “CMS’ proposals in the proposed physician payment rule would help people with Medicare navigate cancer treatment and have access to more types of behavioral health providers, strengthen primary care and for the first time, allow Medicare payment for services performed by community health workers.”
Hospitals, provider groups react to new proposals
Provider groups quickly expressed frustration with the physician fee schedule and called on Congress to reevaluate how the program pays doctors.
“The proposed Medicare physician payment schedule released today is a critical reminder that patients and physicians desperately need Congress to develop a permanent solution that addressed the financial instability and threatens access to care,” said Jesse Ehrenfield, president of the American Medical Association.
Anders Gilberg, senior vice president of government affairs for the Medical Group Managers Association, agreed. “Medicare already largely fails to cover the cost of furnishing care to beneficiaries, and the proposed cut to the 2024 conversion factor compounds the problem,” he said. “Congress must reexamine existing law to provide an annual physician payment update commensurate with inflation and do away with Medicare’s ‘robbing Peter to pay Paul’ budget neutrality “
Hospital associations also expressed concern. Stacey Hughes, vice president of the American Hospital Association, said the proposed 2.8% payment increase would be insufficient to offset financial headwinds hospitals faced in 2022 and beyond. ”Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized,” Hughes said.
Other CMS proposals addressed a wide range of administration priorities. As part of its health equity emphasis, CMS is proposing coding and payment for several new services to help underserved populations, including addressing unmet health-related social needs that potentially can interfere with the diagnosis and treatment of medical problems.
CMS also proposes separate coding and payment for community health integration services, which would include person-centered planning, health system coordination, promoting patient self-advocacy and facilitating access to community-based resources to address unmet social needs that interfere with the practitioner’s diagnosis and treatment of the patient
In line with President Biden’s cancer moonshot — the goal of giving everyone with cancer access to covered patient navigation services — CMS is proposing payment for principal illness navigation services to help patients with treatment for cancer and other serious illnesses. These services also are designed to include care involving other peer support specialists, such as peer recovery coaches for individuals with substance use disorders.
The rule also proposes coding and payment for social determinants of health risk assessments, which could be furnished as an add-on to an annual wellness visit or in conjunction with an evaluation and management visit.
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According to CMS, the rule also contains important changes to improve access to behavioral health in Medicare. It proposes allowing marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill for their services for the first time. The rule also proposes increased payment for crisis care, substance use disorder treatment and psychotherapy.
“CMS continues to demonstrate commitment to advancing health equity and building a stronger Medicare program,” said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare. “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health — and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.”