ACP Calls on Congress to Prevent Medicare Payment Cuts for Physicians

Medicare’s Final 2023 Physician Fee Schedule Includes Other, More Encouraging Provisions

Statement attributable to:
Ryan D. Mire, MD, MACP

President, ACP

WASHINGTON November 2, 2022 – With the publication of the 2023 Medicare Physician Fee Schedule (PFS), we have confirmation that unless Congress acts, Medicare payments to physicians will be cut as of Jan. 1. The American College of Physicians (ACP) calls on Congress to stop these cuts from going into effect at the end of the year and jeopardizing patient access to care. Medicare payments to physicians have been held flat for years, amounting to a significant decrease when accounting for inflation and the rising cost of running a medical practice. The significant payment cuts that are scheduled for next year must be prevented in order to ensure that medical practices are able to remain open and physicians are able to work with Medicare beneficiaries.

Physician payment cuts are coming, significant changes to E/M services are finalized, and key reporting revisions are hitting telehealth and audio-only services, according to the final 2023 Medicare physician fee schedule.  CMS announced a 4.5% reduction to the 2023 Medicare Part B conversion factor (CF), effective January 1.

The CF will fall to $33.0607 in 2023, down from $34.6062 in 2022, largely due to budget neutrality adjustments. The final CF for 2023 is two cents lower than the rate CMS first proposed in July.

While the payment cuts are a major component of the final PFS, the rule contains other proposals that are more encouraging for internal medicine physicians. We are glad to see that the Centers for Medicare and Medicaid Services (CMS) is finalizing payment increases for inpatient evaluation and management (E/M) codes. E/M codes have long been undervalued, and increases that were made in 2021 to outpatient codes have made progress in correcting this issue and addressing documentation burdens. The finalized changes in the 2023 PFS to inpatient E/M codes will further help to recognize the value of internal medicine, as well as to align documentation requirements across all E/M codes. It is also helpful that the final rule delays the implementation of changes to the split (or shared) E/M visits policy that would require physicians to bill only based on total time.

However, we believe that the delay to 2024 is not long enough, nor does the policy account for the physician contribution to those visits. ACP will continue to work with CMS and others to ensure that these billing requirements are consistent with recent changes to E/M codes, which will necessitate revisions to CMS’ current policies.

We are extremely disappointed to read that the coverage for audio-only services will expire 151 days after the end of the COVID-19 public health emergency. CMS finalized this, despite hearing from ACP and many other stakeholders about the essential role these visits play in maintaining access to care for underserved and rural populations.

ACP is also encouraged to see that CMS finalized changes in the Medicare Shared Savings Program (MSSP) that will address social drivers of health and help to improve health equity. We are especially encouraged by the health equity adjustment within the quality performance category, which begins to integrate health equity into aspects of the MSSP. However, the College reiterates the importance of ensuring these efforts do not contribute to unnecessary administrative burden or unintended consequences. We are also happy to see that CMS finalized the Promoting Wellness MIPS Value Pathway that is similar to a pathway on Preventive Care that ACP had previously suggested to CMS.

ACP will continue to strongly advocate with Congress to prevent the scheduled payment cut before the end of the year and ensure stability in physician payments. We will also continue to work with CMS and other stakeholders to tackle the concerns we have for next year’s fee schedule and to work toward a better payment system.

CMS intends to adopt the telehealth waiver extension that Congress passed in Consolidated Appropriations Act of 2022. The extension locks in a wide range of telehealth waivers for 151 days after the PHE expires, including the audio-only exceptions that have been popular with providers; the waiver of geographic and other limits ordinarily required for telehealth services; and the ability of therapists, occupational therapists, speech-language pathologists, and audiologists to bill such codes under telehealth.

For the Merit-based Incentive Payment System (MIPS), the category weight in 2023 will be 30% for Quality, 30% for Cost, 15% for Improvement Activities, and 25% for Promoting Interoperability. The data completeness threshold rises from 70% to 75%.

CMS will take applications for the MIPS Value Pathways (MVP) program that will eventually replace the current MIPS structure. The agency will also add five new MVPs to the seven in its MVP inventory.