Search

Congress Passes Partial Fix to Medicare Physician Payment

Mar 06, 2024
Medicare
Payment Reform
Physician Fee Schedule
An exterior shot of the United States Capitol building

Congress has passed a partial government funding bill March 8 that includes policies to address cuts to the Medicare Physician Fee Schedule (MPFS) that went into effect on Jan. 1.   

Updated March 10, 2024

Congress has passed a partial government funding bill March 8 that includes policies to address cuts to the Medicare Physician Fee Schedule (MPFS) that went into effect on Jan. 1. 

The legislation softens the decrease from -3.37% to -1.69% and would take effect on March 9 running to the end of 2024. It does not provide for retroactive claims processing.

Although the Academy appreciates both that Congress has acted and the tireless efforts of our congressional champions, we are deeply disappointed that lawmakers did not eliminate the full cut to physician payment and that much needed, long-term physician payment reforms remain unaddressed.

“I’m glad to see Congress took action,” Academy CEO Stephen D. McLeod said. “However, it is distressing that the full cut was not eliminated, and this partial fix is still far from what is needed to bring long-term certainty and stability to a dysfunctional Medicare physician payment system. Congress must act on broader reforms to ensure that physicians can be there for all the patients who need them.”

The time is past due for Congress to enact long-term solutions to the Medicare physician payment system. Some of the solutions we support are:

  • The Strengthening Medicare for Patients and Providers Act (HR 2474): If enacted, this legislation would provide an annual physician payment update tied to the Medicare Economic Index (MEI). The index measures inflation, including the cost of running a practice, increases in office rent, employee wages, and professional liability insurance premiums.
  • The Provider Reimbursement Stability Act (HR 6371): This legislation would reform the Medicare Physician Fee Schedule budget neutrality policies by:
  • Requiring CMS to reconcile inaccurate utilization projections based on actual claims and prospectively to revise the conversion factor accordingly
  • Raising the threshold that triggers a budget neutrality adjustment from $20 million to $53 million and increase it every five years by the MEI cumulative increase
  • Requiring the direct inputs for practice expense relative value unit (i.e., clinical wages, prices of medical supplies and prices of equipment) to be reviewed concurrently and no less often than every five years
  • Requiring CMS to limit positive or negative budget neutrality adjustments to the conversion factor to 2.5% each year

While these are not the only reforms needed, these have broad support in the physician community and bipartisan support on Capitol Hill.

The status quo cannot continue as it is. The Academy will continue to work with our coalition partners in the house of medicine to find lasting solutions to this issue to ensure ophthalmologists can focus on protecting sight and empowering lives. This issue will be at the top of the list for Congressional Advocacy Day at Mid-Year Forum 2024.

Sign up to join your colleagues on Capitol Hill to tell Congress how this inaction is hurting you and the patients you treat.

Explore the Issues Further

Payment Reform
Physician Fee Schedule

Related Stories

Member exclusive Fallback image

CMS Proposes Adverse Changes to Payments for E/M Visits Billed With Global Procedures

The Academy will be advocating against a Centers for Medicare & Medicaid Services' proposal on evaluation and management (E/M) visits that inappropriately reduces reimbursement and puts patient care and practice viability at risk. 

Member exclusive
An ophthalmologist advocates on Capitol Hill.

Bipartisan Group Introduces Medicare Physician Payment Bill

This new bill, introduced by physician lawmakers, starts an important conversation on how to avoid proposed cuts to Medicare reimbursement in 2027 and provides a great opportunity for ophthalmology to weigh in and influence future legislation. 

Member exclusive
Ophthalmologist Raj Maturi, MD, with a patient in his clinic.

2027 Fee Schedule Proposes Cutting Pay to Physicians by 1.68%

The Centers for Medicare & Medicaid Services (CMS) has released its proposed Medicare Physician Fee Schedule for 2027. Here are the highlights based on the Academy’s analysis. The Academy will work with our advocacy partners to ensure finalized policies support our members and their patients.

Latest Updates

See All Articles
Member exclusive Fallback image

Join in ELSA Week of Action

 As part of the Ensuring Lasting Smiles Act (ELSA) Week of Action, the Academy and American Association for Pediatric Ophthalmology and Strabismus (AAPOS), in partnership with the ELSA Coalition, are contacting members of Congress and encouraging action in support of ELSA.

Member exclusive
Ophthalmologist Jeffrey Carlisle, MD, and team

CMS Proposes Significant MIPS Changes in 2027 Fee Schedule

The Centers for Medicare and Medicaid Services’ (CMS) proposed 2027 rule would sunset Traditional MIPS, mandate MVP reporting, and add a core measure requirement. Here's what you need to know.

Member exclusive
Ophthalmologist Nicole Bajic, MD, examines a patient in her clinic.

Milestone Moment: Seniors' Act Advances Unanimously Through Ways & Means Committee

Thanks to Academy advocacy and leadership, and the voices of members like you, the Seniors’ Act cleared a major hurdle in reforming prior authorization in Medicare Advantage. Let’s keep pushing until it becomes law.

See All Articles