Cardiology groups celebrate bill that could improve Medicare payments
Cardiology groups are applauding a bill in Congress that could become an important legislative initiative to help fix one of the biggest reimbursement issues facing cardiology—Medicare's budget neutrality policy.
The Provider Reimbursement Stability Act (HR 8163) legislation modernizes and updates the underlying mechanics of the Medicare Physician Fee Schedule (MPFS) to improve stability for physicians and their patients. The bill was introduced in March and passed in the House Ways and Means Committee May 21. It now has a total of 44 co-sponsors.
Medicare is required to live within its budgeted ceiling to pay physicians. This means that, as costs rise and as the population ages, Medicare maintains a neutral budget by cutting what it pays doctors. There also is no inflationary increase for physician payments, but there is one for hospital payments. Physicians groups have lobbied Congress for years to do something about this policy.
The American Medical Association calculates that budget neutrality combined with the lack of inflationary increases has resulted in a 33% cut in physician pay since 2001. This has been a driving factor behind the mass consolidation of cardiology practices into larger health systems.
HR 8163 would raise the Medicare Physician Fee Schedule budget-neutrality threshold from $20 million to $54.3 million. It would also index the threshold to the cumulative percentage increase in the Medicare Economic Index (MEI) every five years. In addition, it would require claims-based corrections to utilization estimates, mandate more frequent practice-expense updates and cap annual conversion-factor adjustments at ±2.5% beginning in 2027.
"Physicians in America have been crushed for decades by persistent cuts to the Medicare Physician Fee Schedule," Congressman Greg Murphy, MD, the bill's sponsor, said in a statement. "Access to high-quality, affordable care is drying up around the country, particularly in rural communities because reimbursement is less than the cost of care. These reductions are driving independent physicians out of practice, either to retire early, sell out to private equity, or be acquired by consolidated hospital systems. The first leads to fewer physicians, and the latter two drive up costs. This methodology is unacceptable, especially given the severe physician shortage our country faces."
He said some MPFS reimbursement provisions have not been updated since the fee schedule was established in 1992. This bill would provide updates to the direct costs used to calculate practice expense relative value units (RVUs) at least every five years.
"America is losing private practice doctors to hospital empires at an alarming rate and part of the blame lies with unpredictable Medicare reimbursements for physicians," Ways and Means Committee Chairman Jason Smith said in a statement. "This bill protects patient access to care by stabilizing payments and limiting unintended reimbursement cuts for the doctors who care for them."
Heart Rhythm Advocates, the advocacy arm of the Heart Rhythm Society (HRS), sent an update to HRS members that cites the bill's advancement as major progress.
"This bill would make targeted reforms to Medicare’s budget neutrality framework. The bill would increase the outdated budget neutrality threshold, require CMS to use more accurate utilization data when calculating payment changes, require more frequent updates to practice expense inputs, and limit large year-to-year swings in physician reimbursement," the group wrote.
HRS haș particular interest in the bill because the group says electrophysiologists face payment instability under Medicare that has a direct impact on its ability to attract and pay for highly trained staff. EP also has long procedure times and often requires complex care coordination, which HRA says is not adequately reimbursed. The group says this is being further compounded by a growing patient demand driven by an aging population.
The American Society of Nuclear Cardiology (ASNC) is also encouraging members to contact their congressmen to push for the advancement of this bill.
"Physician payments are further eroded by frequent and large payment redistributions caused by budget neutrality. Revising budget-neutrality requirements should be a top priority for Congress. Because of changes to clinical labor pricing inputs, nuclear cardiology practices faced four years of phased in payment reductions," ASNC wrote in its summary report for this bill.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]