MAY 11, 2022
Academy Joins Campaign to Advance Medicare Physician Payment Reform
In the face of continued cuts to physician payments scheduled for 2023 and with a new class in Congress, the Academy has joined the American Medical Association and others in an organized effort to educate lawmakers on much-needed Medicare physician payment reform.
The AMA met last month with the key congressional committees with jurisdiction over Medicare, sharing research on the challenges that Medicare program has for physicians. Physicians are the only Medicare providers whose payment updates do not take into account market changes in the cost of providing services. Notably, the current payment system has failed for decades to recognize increase in practice costs and, as a result, the system is woefully underfunded.
The campaign we are launching this month includes five “asks” — immediate needs — and a set of reform principles that the new Congress will need to consider going forward. This represents the first stage in medicine’s effort to develop and propose substantial changes to the payment system to improve physician practices’ financial viability and ease their administrative burdens.
Follow updates through our Washington Report Express and on social media for grassroots actions you can take, like writing to Congress or scheduling meetings during the upcoming August recess. Your voice is important: Medicine faces nearly 9% in cuts under the current Medicare fee schedule unless Congress intervenes before the end of the year.
Medicine needs an annual update related to the cost of practice like other Medicare providers, such as hospitals and nursing homes. Congress must intervene before the end of the year if we are to derail that nearly 9% in cuts under the current Medicare fee schedule.
Medicare Pay Updates Compared to Inflation 2001-21
Sources: AMA Economic and Health Policy Research, October 2021
We are asking for:
- Immediate extension of congressionally enacted 3% temporary increase in the Medicare physician fee schedule conversion factor
- Avoids payment cuts associated with budget neutrality adjustments tied to the payment boost for evaluation and management (E/M) visits
- At minimum, scheduled and anticipated cuts in payments to be replaced with positive, inflation-based updates for at least the next two years while innovative models consistent with Medicare physician payment reform goals are developed and implemented
- Waiving the 4% PAYGO sequester necessitated by passage of legislation unrelated to Medicare
- Extending the MIPS $500 million annual pool for exceptional performance
- Passing the Value in Health Care Act (HR 4587) to facilitate movement to Alternative Payment Models (APM)
- Extension of the expiring 5% bonus for participating in an Advanced APM
- Extension of the lower thresholds required for Advanced APM participation at 50% instead of 75% level
This is the first step in the effort the Academy has been working on with the AMA to guide our advocacy efforts on Medicare physician payment reform. The release of the solutions that are unifying medicine will be the next phase of the campaign.