CMS Finalizes 2024 Physician Fee Schedule

Last Thursday, the Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule rule, which includes a 3.34% decrease to the schedule’s conversion factor, setting it at $32.74, a $1.15 decrease from 2023.

The agency finalized other increases for visits including primary and longitudinal care, and said that the increases would require cuts in order to maintain budget neutrality, Fierce Healthcare reports. It also finalized the implementation of a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211, which will be used for resource costs associated with primary and longitudinal care.

A CMS fact sheet on the Medicare Shared Saving Program (MSSP) changes also notes that some of the finalized changes include moving accountable care organizations (ACOs) toward a digital measurement of quality called the Medicare Clinical Quality Measure (CQM) beginning in 2025. It also highlighted changes to the financial benchmarking methodology for ACOs, which would cap ACO risk score grown in a regional service area and eliminate negative regional adjustment to the benchmark.

Diagnostic radiology and radiation oncology are set to receive a 3% pay decrease, interventional specialists will receive a 4% decrease. Radiology Business notes that the decreases could have been more severe, but the cuts do not account for payment changes related to the Consolidated Appropriations Act. Additionally, the Appropriate Use Criteria (AUC) program, which would have required physicians to consult a decision-support system prior to ordering advanced imaging, was cut from the final rule.

From the American College of Radiology (ACR), which supported the implementation of AUC:

The ACR recognizes the significant issues CMS faces with the real-time claims processing aspect of the AUC program and the potential impact on our members should claims be denied inappropriately.

And this was far from the last of the institutional responses from advocacy groups offended by the final rule. The American Medical Association President Jesse M. Ehrenfeld, M.D., M.P.H, took issue with the agency’s apparent disregard for inflationary costs:

This is a recipe for financial instability. Patients and physicians will wonder why such thin gruel is being served.

Last month, in anticipation of the cuts, the Medical Group Management Association (MGMA) appealed to the House Committee on Energy and Commerce Subcommittee on Health to pass the “Strengthening Medicare for Patients and Providers Act,” which would tie Medicare physician payments updates to inflation based on the Medicare Economic Index, Medical Economics reports.