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  • Congress Passes Partial Fix to Medicare Physician Payment

    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.