The recent updates finalized by the Centers for Medicare & Medicaid Services (CMS) to its physician fee schedule for 2024 and the rule for next year’s Outpatient Prospective Payment System (OPPS) have sparked dissatisfaction among provider groups.
Summary of the Article:
Physician Fee Schedule for 2024: CMS has set the physician fee schedule conversion factor for 2024 at $32.74, down from $33.89 in 2023. This represents a decrease of $1.15 or 3.4%. The updated rule will reduce physicians’ Medicare payments by 1.25% in 2024, following a 2% reduction in 2023.
Provider Groups’ Reaction: Provider groups, including the American Medical Association, have expressed disappointment with the updated rules. They argue that the changes do not keep up with inflation and will lead to financial instability for patients and physicians, particularly affecting small, independent, and rural practices.
New Add-On Payment Code: CMS will establish a separate add-on payment for healthcare common procedure coding system code G2211, aimed at better accounting for the resource costs associated with complex patient visits. However, the Medical Group Management Association criticized this approach as inadequate for ensuring fair compensation.
Medicare Hospital Outpatient Prospective Payment System: For 2024, CMS will increase outpatient payment rates by 3.1%, which is seen as inadequate by groups like the American Hospital Association due to the financial challenges hospitals face.
340B-Acquired Drug Payment Policy: CMS plans to issue a $9 billion lump sum payment to hospitals participating in the 340B program as a remedy for illegal payment cuts from 2018 to 2022. However, this will be offset by future payment cuts in other areas, a decision that has been criticized by industry groups.
Insights:
- Financial Challenges in Healthcare: The article highlights the ongoing financial challenges faced by healthcare providers, especially in the context of rising operational costs and inflation.
- Impact on Small and Rural Practices: The dissatisfaction expressed by provider groups suggests that the new CMS rules could disproportionately affect small, independent, and rural practices, potentially impacting patient access to care in these communities.
- Complexity of Healthcare Payment Systems: The controversy over the 340B program and the new CMS rules reflects the complexity and contentious nature of healthcare payment systems in the U.S., underscoring the need for policies that balance financial sustainability with access to quality care.