Cardiologists, heart surgeons and imaging experts push for changes that could prevent ‘permanent and unjustifiable Medicare cuts’
Several U.S. medical societies focused on cardiology and cardiovascular health have joined more than 100 other groups in support of a new proposal that would reform budget-neutrality policies and help limit further cuts to the payments from Medicare physicians receive for their services.
The American College of Cardiology (ACC), American Society of Echocardiography, American Society of Nuclear Cardiology, American Society of Transplant Surgeons, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions (SCAI), Society of Cardiovascular Computed Tomography, Society for Vascular Surgery and Society of Thoracic Surgeons all signed on to the letter, supporting efforts led by the American Medical Association to help push the proposal forward until it becomes the law of the land.
The proposal in question, The Provider Reimbursement Stability Act of 2023, was put forward in October 2023 by U.S. Reps. Greg Murphy (R-NC), Brad Wenstrup (R-OH) and Michael Burgess (R-TX), who all have experience as practicing medical professionals. The policy, if signed into law, would raise the country’s budget-neutrality threshold from $20 to $53 million and then raise it again every five years as necessary based on the Medicare Economic Index.
This is similar to the language included in the Strengthening Medicare for Patients and Providers Act, a piece of legislation many of these same medical societies endorsed in April.
Another change included in the new proposal would allow any budget-neutrality adjustments that are still required to be limited to 2.5% per year, an update the medical societies said would “provide greater stability” and remove “relatively large and abrupt changes.”
The medical societies concluded their letter by thanking Wenstrup, Murphy and Burgess for putting this proposal forward.
“Enactment of the policies in the discussion draft, combined with other reforms such as an annual payment update tied to inflation, promise to improve the financial viability of physician practices—particularly those in rural and underserved areas,” the groups wrote. “We look forward to working with you and your colleagues in this endeavor.”
Why are budget-neutrality policies so important?
One of the primary reasons the Medicare Physician Fee Schedule (MPFS) often includes reductions in Medicare payments for various therapies and procedures is that Medicare programs are required by law to be budget neutral. If physician reimbursement payments are increased for one treatment, for example, payments must be reduced for another treatment to maintain a neutral budget. If the budget-neutrality threshold is increased to $53 million, it would give Medicare much more room to play with before considering cuts that impact the day-to-day lives of U.S. physicians.
In their letter, the groups pointed to an example of how budget-neutrality requirements impact physicians: a single Medicare decision caused reimbursement payments to drop by more than $5.2 billion from 2013 to 2021.
“The net result in these circumstances is not budget neutrality, but rather permanent and unjustifiable Medicare cuts to physician payments across the board,” the groups wrote.
The 2024 MPFS is final—could policies change by 2025?
The Centers for Medicare & Medicaid Services (CMS) finalized the 2024 MPFS on Thursday, Nov. 2. This final rule included a conversion factor of $32.7375, down 3.39% compared to the 2023 MPFS.
While the ACC’s initial estimate is that reimbursement for cardiology is largely unchanged, this reduced conversion factor is still expected to make a significant impact on providers throughout the country.
Groups are already making their disappointment in the 2024 MPFS known. A new statement from SCAI, for instance, emphasizes the impact these continued cuts are having on patient care. The group also highlighted the importance of new policies going forward.
“We are disappointed that CMS’ final rule for the 2024 PFS continues to slash Medicare reimbursements for physicians, threatening to exacerbate the effect of two decades of payment cuts, undermine physician participation in Medicare, and jeopardize patient access to care. Interventional cardiologists and other physicians must now endure a further decrease in reimbursement despite the rapid rise of practice costs,” SCAI President George D. Dangas, MD, PhD, said in the statement. “SCAI urges Congress to prevent these cuts and to implement a fair and sustainable solution for our broken Medicare physician reimbursement system, including a regular update to payments based on the Medicare Economic Index.”
The Strengthening Medicare for Patients and Providers Act and this latest proposal from Wenstrup, Murphy and Burgess suggest help could be on the way. Will any of these policies gain enough momentum to impact care in 2025? Cardiologists, heart surgeons and cardiac imagers throughout the country certainly hope so.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.