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Efforts to Reform the Medicare Physician Payment System Continue

Efforts to advance legislation to prevent Medicare payment cuts and adopt long-term reforms continue, with Congress taking several steps on one of neurosurgery’s top advocacy priorities.

  • Establishing an Automatic Inflation Update for Physicians. Earlier this year, Reps. Raul Ruiz, MD, (D-Calif.); Larry Bucshon, MD, (R-Ind.); Ami Bera, MD, (D-Calif.) and Mariannette Miller-Meeks, MD, (R-Iowa) introduced the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would put in place an annual physician payment update starting in 2024 based on the Medicare economic index (MEI). The MEI reflects increases in physician practice costs and would reverse a downward spiral of Medicare physician payments, which have failed to keep pace with inflation, jeopardizing the viability of physician practices and patients’ timely access to care.

  • Reforming Medicare’s Budget Neutrality Rules. Under current law, policy changes in the Medicare Physician Fee Schedule (MPFS) each year that exceed $20 million requires an across-the-board decrease in payments to all physicians through reductions in the Medicare conversion factor. Over the years, this budget neutrality rule has led to significant cuts to specialists, including neurosurgeons. To help stabilize physician payments by improving how the Centers for Medicare & Medicaid Services (CMS) calculates the budget neutrality adjustment, House Doc Caucus members, including co-chairs Reps. Greg Murphy, MD, (R-N.C.); Brad Wenstrup, DPM, (R-Ohio) and Michael Burgess, MD, (R-Texas) teamed up with Rep. Robin Kelly (D-Ill.) to introduce the Provider Reimbursement Stability Act (H.R. 6371), which would reform the MPFS budget neutrality requirements. This bipartisan legislation would add crucial stability and predictability to Medicare physician payments by:

    • Requiring CMS to reconcile inaccurate utilization projections based on actual claims;
    • Raising the budget neutrality threshold from $20 million to $53 million and increasing it every five years by the cumulative increase in the MEI;
    • Updating practice expense inputs, such as clinical labor costs, at least every five years; and
    • Limiting the year-to-year conversion factor variance to no more than 2.5% each year.

    On Oct. 31, the AANS and the CNS joined 120 national medical societies and state medical associations supporting this effort. Click here to read the medical groups’ letter.

  • House Subcommittee Considers Medicare Proposals. On Oct. 19, the House Energy and Commerce Health Subcommittee held a legislative hearing titled “What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care and Minimize Red Tape for Doctors.” The hearing featured several bills related to the MPFS. Click here for details.

    Subsequently, on Nov. 15, the subcommittee advanced the Budget Neutrality Reform Bill (H.R. 6371) and H.R. 6369, which would extend incentive payments for physicians participating in eligible alternative payment models through 2026. During this hearing, Rep. Bucshon offered an amendment to provide physicians with an MEI-based inflationary update for 2024. Reps. John Joyce, MD, (R-Pa.) and Kim Schrier, MD, (D-Wash.) also teamed up to offer an amendment to prevent the entire 3.4% 2024 Medicare cut. Unfortunately, due to their costs, the amendments were withdrawn. Click here for details.

  • Senate Finance Committee Advances Bipartisan Health Care Legislation. On Nov. 8, the Senate Committee on Finance advanced the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act by a 26-0 vote. The legislation includes policies to address pending Medicare and Medicaid payment cuts. Specifically, this bipartisan legislation would eliminate scheduled Medicaid Disproportionate Share Hospital cuts for fiscal years 2024 and 2025 and mitigate an upcoming 3.4% Medicare Physician Fee Schedule cut by providing an additional 1.25% of relief (if adopted, the cut would be 2.15% instead). The bill would also extend advanced alternative payment model bonuses through calendar year 2026. Click here for details.

  • House Committee Advances Bill to Mitigate Physician Payment Cuts. On Dec. 7, the House Committee on Energy and Commerce unanimously approved the Physician Fee Schedule Update and Improvements Act (H.R. 6545), as amended. Similar to the Senate Finance Committee measure, if adopted, this bill would provide an additional 1.25% of relief and reducing the cut to 2.15%.

  • Legislation to Halt the 3.4% Physician Payment Cut Introduced. On Dec. 7, a bi-partisan group of legislators led by Reps. Greg Murphy, MD, (R-N.C.) and Danny Davis (D-Ill.) introduced the Preserving Seniors’ Access to Physicians Act (H.R. 6683). This bill would eliminate the scheduled 3.4% physician payment cut if enacted.

  • AANS/CNS Washington Office Staff Featured in AMA Webinar. On Nov. 3, Katie O. Orrico, Esq., AANS/CNS senior vice president for health policy and advocacy, participated in an American Medical Association (AMA) Advocacy Insights webinar, “What’s next with Medicare payment reform.” Moderated by AMA board chair Willie Underwood III, MD, the webinar addressed where Medicare payment reform stands now, how the AMA, alongside state and national medical specialty societies, is pushing for permanent payment reform and ways for physicians to get involved in these advocacy efforts. Other participants included G. Ray Callas, MD, president-elect of the Texas Medical Association and Todd Askew, AMA’s senior vice president for advocacy. Click here to watch the webinar.

The AANS and the CNS will continue their efforts to prevent Medicare cuts next year and adopt longer-term reforms. To this end, on Nov. 6, the neurosurgical societies joined two coalition efforts urging Congress to stop the 3.4% pay cut. Click here and here to read the letters. Additional information and resources are available at the AMA’s Fix Medicare Now website.