番茄社区

Healthcare organizations seemed pleased with a on problems with physician payment under the Medicare fee-for-service program, even though the paper was vague on some plans for addressing the issues presented.

"MGMA [the Medical Group Management Association] is encouraged to see [the] Senate Finance [Committee] taking an important step toward meaningful Medicare physician payment reform, examining potential solutions to ensure the financial solvency of medical practices and protect beneficiary access to care," said Anders Gilberg, MGMA's senior vice president of government affairs, in a statement. (Disclosure: Gilberg is a member of the 番茄社区 editorial board.)

"Paramount is the need for an annual physician payment update commensurate with inflation, and modernization of the antiquated Medicare budget neutrality policies that can only be described as 'robbing Peter to pay Paul,'" he added.

The National Association of ACOs (accountable care organizations; NAACOS) was similarly complimentary. "NAACOS applauds the Senate Finance Committee for their thoughtful paper exploring the challenges associated with physician payment reform and sustainability," President and CEO Clif Gaus, ScD, said in a statement. "We are very encouraged by its discussion on options that continue to incentivize value-based care. NAACOS supports considering alternatives to the current bonus structure, including ways to eliminate participation thresholds, and better updates than the current conversion factor."

The white paper, issued Friday, begins by explaining how physician payment works under Medicare's Part B program, noting that in 2022, payments under the Medicare Physician Fee Schedule (PFS), including cost-sharing by Medicare beneficiaries, "totaled $91.7 billion, accounting for slightly below 17% of all Medicare fee-for-service spending."

The authors also noted that in the same year, nearly 1.3 million clinicians billed Medicare under the PFS.

The paper addresses the fact that one component of the fee schedule -- the "conversion factor," or multiplier, that is used to set the fee for each service or procedure -- doesn't get adjusted annually for inflation. "As one of the few Medicare providers without a payment update tied to inflation, physicians have watched inflation-adjusted payments decline 26% from 2001 to 2023," the authors wrote. However, they also pointed out that "at the same time, per-beneficiary spending has grown 'substantially faster' than MEI [the Medicare Economic Index, a measure of healthcare inflation] or PFS updates, indicating that when accounting for increased volume and intensity of services, overall physician compensation has exceeded inflation."

The white paper doesn't gravitate to a specific policy option in that instance, saying instead that the committee "shares stakeholders' and experts' concerns" about whether independent physician practices can stay in business and is "interested in examining the role of the current-law conversion factor update schedule, particularly over the longer term ... The committee is also interested in exploring policy options that would update the conversion factor in a more predictable manner."

On the value-based care side, the paper expresses concern about the approaching end -- in 2026 -- of the payment bonus for providers who participate in (AAPMs) such as certain types of ACOs. "To date, the largest ... bonus has amounted to 2.34%, making participation in AAPMs more financially attractive to providers," the authors wrote. "However, stakeholders and experts have expressed concerns that this dynamic will begin to shift as the AAPM incentive bonus ends ... The committee is interested in exploring ways to improve and sustain meaningful incentives for AAPM participation."

The Merit-Based Incentive Payment System (MIPS) -- the vehicle for paying providers who aren't participating in AAPMs -- received some harsh scrutiny from the committee. MIPS requires clinicians to report on the quality of their practices via a list of pre-approved quality measures; practices choose a certain minimum number of measures on which they will report.

"The committee has heard repeatedly of the immense administrative burden placed upon providers subjected to MIPS reporting requirements," the paper noted. "Regarding primary care physicians, the MIPS program may not accurately capture the quality of care provided: a of 80,246 primary care physicians found that MIPS scores were inconsistently related to performance on process and outcome measures, and that physicians caring for medically complex patients were more likely to receive low MIPS scores even when delivering relatively high-quality care."

"Numerous experts and stakeholders ... have recommended eliminating the MIPS program," the authors wrote. "Given the lack of improvement in patient outcomes and quality of care, the Finance Committee is considering repealing or scaling back the MIPS program to relieve physicians' administrative burden and alleviate churn from AAPMs back to MIPS."

Preserving beneficiaries' access to telehealth was another committee focus. The white paper explained that certain telehealth flexibilities -- including elimination of geographic restrictions on the location of a beneficiary receiving telehealth, and allowing the use of audio-only telehealth visits -- that were permitted during the COVID-19 public health emergency are set to expire at the end of the year.

Concerns have arisen that not renewing these provisions "would likely result in diminished healthcare outcomes for scores of seniors," the paper said. "With those considerations in mind, the committee plans to engage in a bipartisan, bicameral basis to chart a responsible path forward that preserves access to crucial telehealth services under Medicare fee-for-service."

The authors concluded by noting that the white paper "will serve as the foundation for another impactful legislative effort, focused on bolstering clinician care, particularly for Medicare beneficiaries with chronic diseases. The committee looks forward to continued engagement with experts, stakeholders, and members of the committee on policy concepts and options."

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