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  • Academy Comments on CMS’ 2024 Medicare Program Proposals

    The Academy submitted comments to the Centers for Medicare & Medicaid Services (CMS) last week that express ophthalmology’s concerns about the proposed 2024 Medicare Physician Fee Schedule. 

    Our comments, which are based on months of analysis, focus on the disruption for practices and downstream effect on patients from the proposed fee schedule conversion factor cut, our opposition to a new add-on code for visit complexity and concerns over plans to increase the performance threshold in the Merit-Based Incentive Payment System (MIPS) program.  

    Totaling 35 pages, they cover a broad array of issues in the proposed rule that may affect your practice. We encourage our members to review the document in its entirety (PDF).   

    2024 Conversion Factor

    The proposed 2024 Physician Fee Schedule conversion factor is $32.75, a decrease of $1.14 (3.36%) from 2023. The Academy argued the urgent need for policy intervention to address this significant reduction, emphasizing the disruption it will impose on medical practices and the unique decrease to physician payment despite increases in other areas of health care spending and overall inflation.  

    We urged CMS to engage with Congress to ensure appropriate physician payment in 2024 and to sustainably reform the Medicare payment system.   

    G2211 Add-On Code  

    The proposed CMS-generated add-on code would provide additional payment for visit complexity inherent to evaluation and management (E/M) visits associated with medical care services that serve as the continuing focal point for all needed health care services, and/or with services that are part of ongoing care related to a patient’s single, serious or complex chronic condition.  

    The Agency first proposed G2211 in its 2021 rulemaking cycle, but Congress intervened and postponed its possible implementation until at least 2024 due to concerns from the clinical community and the Medicare Payment Advisory Commission. Despite years of objections, CMS has proposed to make the code reimbursable effective Jan. 1, 2024.  

    The Academy has reiterated our opposition to the add-on code in our 2024 comment letter, highlighting the following concerns: 

    • The add-on code is no longer needed because the original rationale for its creation has been addressed by the updated E/M coding structure and the development of numerous separately reportable codes to account for additional services.
    • The add-on is not resource-based and would undermine the Resource-Based Relative Value Scale that serves to equitably allocate Medicare physician payments. 
    • There is significant uncertainty around how to document, code and bill the code correctly. It is unclear if and how ophthalmologists might use this code.
    • CMS created G2211 strictly for use on Medicare claims; therefore, there is no guarantee that payors other than Medicare will pay for code. We anticipate non-coverage denials from commercial payors and Medicaid.
    • Patients may owe more out-of-pocket and could be confused by the additional G2211 charge on their explanations of benefits.
    • CMS’ utilization estimates appear inaccurate, and it is unclear how the agency arrived at its proposal. These estimates drive the magnitude of the budget neutrality cut. 

    While G2211 may increase allowed charges for some providers, it comes at the expense of a significant conversion factor cut for all Medicare providers. CMS estimates as much as 2% of the 3.36% conversion factor cut scheduled to take effect in 2024 is attributable to its proposed implementation of the Medicare-specific G2211 add-on code due to anticipated impacts on budget neutrality. 

    In our letter, the Academy urged CMS to abandon implementation of G2211.

    Quality Payment Programs and MIPS Changes 

    CMS has proposed increasing the performance threshold in the MIPS to 82 points for performance year 2024 (up from 75 in 2023). This increase comes as the agency is also working to transition providers to the new MIPS Value Pathways and will make it even more challenging for providers to avoid the 9% payment penalty to be applied in 2026.

    Our comment urges CMS to revisit this proposal, citing concerns about the methodology proposed to set the new threshold, the number of providers expected to receive negative adjustments, and making major changes so closely following the end of the public health emergency associated with the COVID-19 pandemic. This increase is not required under the current law, and we believe CMS should keep the threshold at 75 points for performance year 2024.