HRS Supports Physician Payment Reform While Debt Ceiling Negotiations Loom Over Potential 2024 Medicare Physician Payment Cuts

Congress and the White House continue negotiations to address crossing the national debt limit set by Congress. At the time of this publication, the path to resolution is unclear. However, because significant financial fall out is anticipated if Congress does not address the issue, there continues to be hope that a deal will be reached prior to the federal debt limit being crossed sometime in early June.

After the federal debt limit is addressed, it will quickly be time to address the expected calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) cuts. The exact scale of the cut will be better understood when the Centers for Medicare and Medicaid Services (CMS) release the CY 2024 MPFS proposed rule in late June or early July. While there are policies that CMS could put forward that will change the scope of these payment adjustments, cuts are expected from at least two primary sources: (1) a Congressional "patch" to reduce MPFS payment reductions will decrease from 2023 to 2024 by 1.25%; and (2) the reintroduction of a CY 2021 CMS-devised add-on code for "complexity" that Congress prohibited from implementation for 3 years. At the time the "complexity" add-on code was slated for implementation, it would have resulted in an over 3.0% reduction to the MPFS conversion factor due to statutory provisions that require CMS relative value unit (RVU) adjustments to be "budget neutral." These factors, plus others that CMS might introduce in the CY 2024 proposed rule, threaten to once again subject physicians treating Medicare patients to payment reductions and doing so during a period of significant inflation.

To proactively engage on this issue, HRS has partnered with other medical societies to stop these cuts and to support changes to the underlying policies that are driving these cuts (i.e., the application of a budget neutrality policy to a payment system that has no annual update factor to account for inflation). Recently, HRS joined the American Medical Association (AMA) and nearly 120 other medical societies to urge Congressional action, specifically thanking co-sponsors for the introduction of H.R. 2474, The Strengthening Medicare for Patients and Providers Act. While budget neutrality provisions would still apply, this legislation would provide the MPFS annual payment update factor that would increase funding each year by the Medicare Economic Index (MEI). The legislation was introduced by Rep. Raul Ruiz (D-Calif), Rep. Larry Buschon (R-Ind.), Rep. Ami Bera (D-Calif.), and Rep. Mariannette Miller-Meeks (R-Iowa), all of whom are physicians. The joint sign-on letter sent to these Members of Congress can be found here.

This engagement follows HRS joining a coalition of medical societies where we reached out to every member of the 118th Congress when they arrived in January of this year, urging them to address these slated annual payment reductions and the lack of an inflationary update in the Medicare Physician Fee Schedule. HRS will continue its work on these issues and engage with other organizations to address the constant threat of these annual Medicare cuts, which have constantly put pressure on electrophysiology practices and threaten Medicare patients' access to care.