Medicare doc pay to fall while hospital outpatient departments will rise
Add Axios as your preferred source to
see more of our stories on Google.
Illustration: Natalie Peeples/Axios
Hospital outpatient departments are in line for a Medicare rate increase next year, while program payments for physicians could decline.
Driving the news: The Centers for Medicare and Medicaid Services on Thursday proposed increasing payment for hospital outpatient services by 2.8% increase, or approximately $6 billion, in 2024.
- In a separate proposal, CMS announced an intended overall 1.25% pay decrease for doctors, though rates would go up for some primary care services.
Why it matters: The proposals illustrate physicians' long-time gripe with their Medicare payment system: while hospitals and other providers can get inflation-adjusted rates, physicians can't, leading to annual declines.
- "The proposed Medicare physician payment schedule released today is a critical reminder that patients and physicians desperately need Congress to develop a permanent solution that addresses the financial instability and threatens access to care," said American Medical Association president Jesse Ehrenfeld.
What they're saying: Provider groups voiced early frustration with the physician fee schedule and called on Congress to re-evaluate the way the program pays doctors.
- "We are gravely concerned that the proposed rule's physician payment cuts contained in CMS' conversion factor would add to physicians' uncertainty about their continued ability to provide the highest quality of care to Medicare patients," said Douglas White, president of the American College of Rheumatology, in a statement.
- Providers also flagged a new code for medically complex cases that will take effect in 2024 as an unfavorable way to address budget neutrality.
- Clinicians were grateful that CMS addressed complex care but worried it will be at the expense of other reimbursements.
- The code "highlights CMS’ flawed approach to addressing inadequate Medicare payments for primary care services using a budget neutral methodology," Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, said in a statement.
Zoom in: The new physician fee schedule proposes expanding a model to treat Medicare patients with diabetes in underserved communities.
- CMS is also proposing marriage and family therapists, mental health counselors and addiction counselors be reimbursed by Medicare. Additionally, the agency floated increased payments for substance use treatment psychotherapy.
The hospital outpatient services proposal would create a Medicare payment category for intensive outpatient mental health services.
- This could close a gap in coverage for Medicare beneficiaries who need more extensive behavioral health care than individual outpatient therapy but don't require partial hospitalization, CMS said in a news release.
- The rule also seeks to modify hospital price transparency regulations to increase hospital compliance.
What's next: Members of the public can comment on both rules until mid-September, and CMS will issue final payment policies later this fall.
