Doctors, therapists and others billing under the physician fee schedule would see an average 2.93% reduction in Medicare pay next year, the Centers for Medicare & Medicaid Services proposed Wednesday.
The rule affects clinicians and therapists who work in nursing homes and other post-acute settings, as well as others who provide technical services to the sector.
The lower payment is triggered by a statutory requirement that resets the conversion factor to $32.36, a decrease of $0.93 from calendar year 2024. Congress has traditionally offset such proposed cuts after they are finalized, but with frustration growing, last year’s patch failed to take effect until weeks after the lower rate had been instituted.
Cuts have totaled 29% since 2001, according to the American Medical Association, which is warning of redcued availability of physicians and other providers, especially among those service patients in rural and underserved areas.
“With CMS estimating a fifth consecutive year of Medicare payment reductions … it’s evident that Congress must solve this problem,” said AMA President Bruce A. Scott, MD. “In addition to the cut, CMS predicts that the Medicare Economic Index [MEI] — the measure of practice-cost inflation — will increase by 3.6%. Facing this widening gap between what Medicare pays physicians and the cost of delivering quality care to patients, physicians are urging Congress to pass a reform package that would permanently strengthen Medicare.”
While Congress has begun to study long-term physician pay reform, a solution this year appears unlikely.
There was some good news in Wednesday’s CMS proposal, including extension of some telehealth flexibilities and an expansion of caregiver training coverage, which skilled nursing providers cheered last year.
For 2025, CMS plans to create new coding and payment for topics that could include education on preventing decubitus ulcer formation, wound dressing changes, infection control, preparing special diets and medication administration.
The agency is also considering adding codes and payment for caregiver behavior management and modification training that could be paid directly to a beneficiary’s caregiver. That training could be delivered via telehealth.
On telehealth, CMS said it was proposing changes for 2025 that would maintain some “important, but limited, flexibilities where possible” and reflect CMS’ goal to maintain and expand the scope of and access to telehealth services where appropriate.
However, CMS noted in a press release, that without Congressional action before Jan. 1, statutory restrictions on geography, site of service, and practitioner type that existed prior to the pandemic will go back into effect. After that date, CMS said, people with Medicare would need to be in a rural area and a medical facility to receive non-behavioral health services via Medicare telehealth.
The American Telemedicine Association on Wednesday night said it was reviewing the rule but urged Congress to act “as soon as possible” to extending or make permanent the pandemic-era flexibilities.
“We are eager to work with CMS and the Biden administration on the draft rule to ensure that telehealth remains a cornerstone of modern healthcare,” said Kyle Zebley, Senior Vice President, Public Policy, ATA and Executive Director, ATA Action. “It is imperative that Congress acts now to maintain the progress we have made in expanding access to telehealth services.”
The rule also proposes incorporating several models tested through the CMS Innovation Center into primary, cardiology and behavioral healthcare frameworks and makes changes to the Medicare Shared Savings Program and Accountable Care Organizations.
“This proposed rule strengthens the care people with Medicare receive, advancing HHS’s goal of a health care system that not only treats those who are sick but also keeps people well,” said Health and Human Services Secretary Xavier Becerra. “The proposed rule continues our implementation of President Biden’s historic prescription drug law. The law lowers costs for seniors and people with disabilities and uses rebates from drug manufacturers to strengthen Medicare. It also increases access to behavioral and dental care, expands access to cancer screenings, and supports caregivers.”
This is a developing story. Check back with McKnight’s for additional coverage.
