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CSRO Encourages Congress to Pass Doc Fix
CSRO contacted over 100 Congressional offices encouraging members to join a letter circulated by Reps. Miller-Meeks, Panetta, Murphy, Ruiz, Bucshon, Schrier, J. Joyce and Bera. CSRO strategically engaged members of the House Energy & Commerce Committee and House Ways & Means Committee, which have jurisdiction over the issue, as well as existing cosponsors of legislation that would fix the Medicare Physician Fee Schedule.
The letter sent by Miller-Meeks et al details a Congressional letter that will be sent from House members to House leadership urging an update to the MPFS. Most notably, the letter urges Congressional Leadership to advance legislation that:
- provides physicians with a permanent, annual inflationary update in Medicare equivalent to the Medicare Economic Index (MEI).
- enacts targeted reforms to statutory MPFS budget neutrality requirements
- raises the current MPFS budget neutrality threshold to be reflective of 2024 dollars
- requires CMS to cross-check utilization assumptions associated with a narrow set of newly unbundled codes that trigger budget neutrality cuts to correct any misestimates
- mandates CMS review key elements of practice expense costs concurrently and no less often than every five years
- limits changes to the MPFS conversion factor to no more than 2.5 percent in a given year
While CSRO continues to advocate for meaningful long-term reform, this immediate fix is essential to prevent the upcoming cuts to physician reimbursement.
Alliance Responds to CY 2025 Conversion Factor Update
The Alliance of Specialty Medicine, of which CSRO is a leading member, submitted comments on behalf of the more than 100,000 specialty physicians to CMS on the outline in the CY 2025 Medicare Physician Fee Schedule proposed rule. The proposed rule suggests another sharp reduction in Medicare payments to physicians, estimated at - 2.8%. In contrast, CMS finalized sizeable increases in most other Medicare provider 2025 payment rates (e.g., inpatient hospitals (2.9%), inpatient rehabilitation facilities (3.0%), hospices (2.9%), and Medicare Advantage plans (3.7%).
Beginning in CY 2026, physician payment rate updates will be adjusted based on participation in the Quality Payment Program as follows: 0.75 percent per year for qualified physicians participating in advanced alternative payment models (APMs) and 0.25 percent for those participating in the Merit-based Incentive Payment System (MIPS). While an improvement over the flat updates over the past
several years, these nominal updates — relative to high rates of inflation and typically negative budget neutrality adjustments — are not sustainable and will impact beneficiary access to care.
The Alliance urged CMS to:
- actively search for opportunities that would provide a more meaningful positive payment update
- work with Congress on a permanent solution to the longstanding challenges facing the PFS, including the lack of a meaningful payment update based on practice costs; and
- work toward a more consistent and regular approach to updating all direct and indirect practice expenses.
Congress Funds Government through Dec. 20
Lawmakers have departed from Capitol Hill for the month of October after clearing a continuing resolution (CR) to fund the federal government through December 20. The stopgap spending bill was advanced by the House of Representatives in a 341-82 vote on September 25, and was passed by the Senate hours later in a 78-18 vote. The CR maintains government funding for all 12 annual appropriations bills at fiscal year 2024 levels. Lawmakers are not scheduled to return to session until November 12, the week after Election Day. While House Speaker Mike Johnson (R-La.) has repeatedly expressed opposition to reliance on a large year-end omnibus spending package, Congress will only be in session for a short five-week lame duck period ahead of the next shutdown deadline in December. The political dynamics surrounding the next round of government funding negotiations are sure to be highly impacted by the results of the November elections.
Reduced Coinsurance for Select Part B Drugs: Oct. 1-Dec. 31
Through the Inflation Reduction Act, select pharmaceutical manufacturers will be required to pay rebates to Medicare if a Part B drug price increases faster than the rate of inflation. From October 1 – December 31, 2024, CMS has selected 54 Part B rebated drugs for an adjusted coinsurance rate, which will be based on the inflation-adjusted payment amount. Medicare and Medicare Advantage enrollees may pay reduced coinsurance during this period. Click here for a list of the selected medications.
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