The Centers for Medicare and Medicaid Services (CMS) has released its 2024 Medicare Physician Fee Schedule (PFS) proposed rule, which details multiple policy changes to Medicare payments for services received on or after Jan. 1, 2024.
The proposal includes a 3.34% reduction to the PFS conversion factor, which falls to $32.75 (from $33.89 in 2023). It also includes pay cuts for multiple specialties—including diagnostic and interventional radiology—but overall reimbursement rates for cardiovascular care do not appear to be affected, according to an initial evaluation by the American College of Cardiology.
Medical societies react to reimbursement cuts
The American Medical Association was quick to share its perspective on the proposed rule, saying the latest round of reimbursement cuts are “a critical reminder that patients and physicians desperately need Congress to develop a permanent solution that addresses the financial instability and threatens access to care.”
“In the face of these growing costs of running a medical practice, physicians have faced the COVID pandemic and increased inflation,” AMA President Jesse M. Ehrenfeld, MD, MPH, said in the AMA statement. “Not only have Medicare payments failed to respond, but physicians saw a 2% payment reduction for 2023, creating an additional challenge at a perilous moment.”
The AMA and many other medical societies, including the ACC, have been throwing their support behind the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would reform the Medicare reimbursement process and potentially put an end to the annual reductions in care.
The Society of Thoracic Surgeons also issued a statement on the proposed rule, highlighting its concerns over yet another round of payment cuts.
“STS and the rest of the physician community will continue to fight for appropriate Medicare reimbursement that keeps up with inflation,” STS President Thomas E. MacGillivray, MD, said in the statement. “Physicians, including those treating the sickest and most comorbid patients, continue to receive across-the-board cuts, while Medicare continues to increase payments to other healthcare sectors automatically. If Medicare and Congress do nothing to stop these devastating cuts, the health and safety of the nation’s seniors will be at risk.”
Inside the proposal: CMS suggests putting AUC on ice, delaying split/shared billing changes
The 2024 PFS proposes pausing implementation of the Appropriate Use Criteria (AUC) program, which was one of the key components of the Protecting Access to Medicare (PAMA) Act of 2014.
According to PAMA, healthcare providers were required to consult clinical decision support software when placing any advanced medical imaging orders. Penalties for not complying with the AUC program were originally scheduled to go into effect in 2017, but they have been delayed again and again over the years. CMS is now proposing that the entire AUC program be put on hold while the agency continues to seek out “a workable implementation approach.”
CMS is also looking to delay the implementation of changes to how split/shared evaluation and management (E/M) visits are billed. The agency is looking to change the definition of “substantive portion” to mean more than half of the total time of the visit, but those changes would now be delayed until at least Jan. 1, 2025.
Another key change in the proposal is that advanced practice practitioners would be able to supervise cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation. The ACC, American Heart Association and other medical societies have been pushing for this change for quite some time, arguing that it will increase patient access to these important services.