The federal Centers for Medicare & Medicaid Services (CMS) on Nov. 2 announced a final rule finalizing changes in the Physician Fee Schedule to go into effect on Jan. 1, 2024. That final rule also includes changes to the terms of participation in the Medicare Shared Savings Program (MSSP).
The announcement of the final rule was posted to the CMS website on Thursday afternoon. It began thus: “On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2024. The calendar year (CY) 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality, affordability, and innovation.”
After going into the background of the current situation, the press release went on to state that, “By factors specified in law, overall payment rates under the PFS will be reduced by 1.25 percent in CY 2024 compared to CY 2023. CMS is also finalizing significant increases in payment for primary care and other kinds of direct patient care. The final CY 2024 PFS conversion factor is $32.74, a decrease of $1.15 (or 3.4 percent) from the current CY 2023 conversion factor of $33.89.
Meanwhile, the leaders at APG, America’s Physician Groups, the nationwide association representing physician groups involved in value-based contracting, responded positively to the provisions of the final rule that will impact the Medicare Shared Savings Program (MSSP). A press release posted to the organization’s website on Thursday evening began thus: “Multiple changes adopted today by the Centers for Medicare & Medicaid Services bode well for physician groups and the nation’s ongoing transition to value-based health care, according to America’s Physician Groups (APG), the largest organization of physicians committed to being held accountable for the costs and quality of health care. Of special note are steps to invigorate the Medicare Shared Savings Program (MSSP), the signature accountable care organization (ACO) model created under the Affordable Care Act.”
“We’re very pleased to see the many changes in store for the Medicare Shared Savings Program, which will only increase the odds that more health care providers will participate in the program,” said APG president and CEO Susan Dentzer, in a statement contained in the press release. “Clearly CMS has listened closely to physicians with long experience in ACOs in making these changes.”
According to APG leaders, “The positive changes in the rule include the following:
• The adoption of Medicare Clinical Quality Measures (CQMs) as an alternative collection type for MSSP ACOs, and the fact that the data completeness requirement will be 75 percent rather than 80 percent.
• The delay until 2025 of the implementation of the Merit-Based Incentive Payment System (MIPS) Promoting Interoperability performance category.
• The aligning of application of the risk adjustment methodology for the performance years and the benchmark years.
• The new add-on payment for HCPCS code G2211, which will better recognize the resource costs associated with evaluation and management visits for primary care and the longitudinal care of complex patients.
• The new stand-alone G code, G0136, for administration of a standardized, evidence-based Social Determinants of Health Risk Assessment, incorporated into MSSP beneficiary assignment and other methodologies.
• The retention of the current practice of APM Entity-level QP determinations.”
“APG’s key concern is the impact of the payment cut in Medicare physician fees inherent in the new rule,” Dentzer said. At $32.74, the so-called conversion factor for 2024 — the dollar multiplier used to convert adjusted relative value units into payment amounts for physician services — will now be $1.15, or 3.4 percent, below the conversion factor for 2023. As a result, “Medicare physician fees will continue to fall even as inflation and practice expenses climb, and many physicians continue to leave the practice of medicine,” Dentzer added. “The situation is unsustainable, and we look forward to working with Congress and other policymakers to redress these fee cuts soon.”
Premier criticizes appropriate-use criteria program changes
On the other hand, leaders at the Charlotte-based association Premier Inc. on Thursday evening came out with criticism of one element in the final rule. In a statement posted to the association’s website, Soumi Saha, senior vice president, government affairs, at Premier, said that, “While Premier recognizes the significant challenges in operationalizing the real-time claims processing aspect of the Appropriate Use Criteria (AUC) program, abandoning the program altogether as CMS does in the CY 2024 Physician Fee Schedule final rule is not the solution and will have a chilling effect on future innovation. This sets a precedent that CMS can reverse course after entities have made significant time and monetary investments to comply with technological advancements, and entities should not be punished for proactively implementing statutory and regulatory requirements in advance of enforcement deadlines.”
Saha went on to state that, “Furthermore, future proposals from CMS that involve investments in technology may be stifled as entities question whether CMS will truly move forward with implementation or abandon its own policy down the road. Given that adoption of technology, and especially artificial intelligence (AI), will be necessary as healthcare continues to evolve and transform, Premier is deeply disappointed in CMS’ lack of support for technological advancements in healthcare and unwillingness to work with Congress and stakeholders to arrive at a workable solution in the best interest of patient care.”