Doctors sound alarm over ‘dangerous’ payment cuts in proposed Medicare Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) has released its proposed rule for the 2025 Medicare Physician Fee Schedule (MPFS), and it once again includes cuts to the reimbursements physicians will receive when treating Medicare patients.
According to the new proposal, the 2025 conversion factor would be $32.36, down approximately 2.8% from 2024. The conversion factor is perhaps the single most important aspect of the MPFS, because Medicare programs are required by law to be budget neutral. CMS can only increase reimbursements for a service if they decrease reimbursements for another service so the budget allocated to Medicare remains balanced. Physician advocates have been pushing policymakers to update this policy for years.
CMS has estimated that the new conversion factor will not make a significant impact on cardiology services. However, these cuts represent the continuation of a trend the American College of Cardiology and other industry groups have been fighting for years.
Physician groups react to the proposed rule
Groups immediately started sharing their initial reactions to the proposed rule. The Society for Cardiovascular Angiography & Interventions (SCAI), for instance, said it is “deeply disappointed by another year of proposed cuts to physician payments.”
“The declining payment rates under the MPFS have harmed patients and physicians, and undermine Medicare’s ability to guarantee access to affordable healthcare for America’s seniors,” SCAI President James B. Hermiller, MD, said in a statement. “Congress should heed the warnings of physician groups, MedPAC, and other stakeholders and act quickly to prevent further cuts to physician pay next year. SCAI also urges Congress to work on long-term reform that ensures a fair and sustainable payment rate that reflects the increased costs physicians incur while operating a practice.”
The Medical Group Management Association (MGMA), which represents more than 15,000 organizations throughout the United States, shared a response of its own.
“CMS has again proposed a negative Medicare Physician Fee Schedule update for 2025 with dangerous implications for beneficiary access to care,” said MGMA Senior Vice President of Healthcare Policy Anders Gilberg. “A 2.8% reduction to the conversion factor would be alarming in the best circumstances, but to propose doing so at a time when 92% of medical groups report increased operating costs and are otherwise struggling to remain financially viable is critically shortsighted. Medicare physician reimbursement is on a dire trajectory and these ongoing cuts continue to undermine the ability of medical practices to keep their doors open and function effectively—the need for comprehensive reform is paramount.”
The American Medical Association (AMA), which often leads efforts to bring about Medicare payment reform, shared a similar perspective.
“The death by a thousand cuts continues,” said AMA President Bruce A. Scott, MD. “Rural physicians and those treating underserved populations see this CMS warning as another reminder of the painful challenges they face in keeping their practices open and providing care. It’s crucial that we ensure both continue.”
The American Academy of Family Physicians, meanwhile, praised some aspects of the proposed rule, but said the 2.8% reduction “once again highlights the urgent need for congressional action to ensure that physician payments keep up with the costs of running a practice.”
The Association of American Physicians and Surgeons also shared its frustration with the proposal. “Despite the promises that MACRA would stop them, payment cuts continue,” the group wrote.
CMS endorses Million Hearts Model for evaluating ASCVD risk
Another key takeaway from the proposed rule is that CMS appears to be sold on the effectiveness of the Million Hearts Model for evaluating atherosclerotic cardiovascular disease (ASCVD) risk.
CMS proposed coding and payment associated with the program, which uses as “standardized, evidence-based” method to evaluate a patient’s 10-year risk of developing ASCVD. CMS reviewed years of data highlighting the impact of the Million Hearts Model before reaching this conclusion.
“We are also proposing coding and payment for ASCVD risk management services that include service elements related to the ABCS of cardiovascular disease (CVD) risk reduction (aspirin, blood pressure management, cholesterol management, smoking cessation), for beneficiaries at medium or high risk (>15% in the next 10 years) for CVD,” the agency added.
Please note: This 2,248-page proposal is jam-packed with policies that will take some time to go through. This is an ongoing story that Cardiovascular Business will continue to watch closely going forward.
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.