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In comments on the proposed 2025 Physician Fee Schedule, ACP expresses support for several provisions but says more than a short-term fix is needed to restore financial stability to Medicare

Sept. 27, 2024 (ACP) -- The �������ý has submitted comments to the Centers for Medicare & Medicaid Services (CMS) about the 2025 Medicare Physician Fee Schedule and expressed support for several reforms. ACP also highlighted its strong opposition to plans to cut payment rates for physician services.

“Many of the proposals in the rule will help to recognize better the value that internal medicine physicians bring to their patients and have the potential to improve continuity and coordination of care,” said Dejaih Johnson, ACP manager of regulatory affairs. “But as in the past, as we approach year's end, we are concerned about the financial instability of the Medicare program and the risk it poses to patient access to care and the primary care workforce.”

ACP urges Congress to take immediate and long-term action to overhaul the Medicare payment system. “If this rule is finalized, it will mark the fifth consecutive year that CMS has cut physician payments,” Johnson said. “We understand that CMS is statutorily constrained by budget neutrality requirements that mandate net pricing increases be offset by spending elsewhere. Still, there must be a coordinated effort between CMS and Congress to implement short-term approaches and to advance structural resolve for a fragmented system. ACP has continued to push for an adjustment that mitigates the cut scheduled for Jan. 1, but real change must take a more permanent approach to avoid ending up in this same situation year-after-year.”

ACP is lobbying Congress to pass the following House bills this year:

• The Strengthening Medicare for Patients and Providers Act, which would preserve access to care for Medicare beneficiaries by providing an annual inflation update equal to the MEI for Medicare physician payment. ACP believes this legislation is essential to physicians' ability to maintain their practices and make needed investments to continue delivering high-quality patient care.
• The Physician Fee Schedule Update and Improvements Act, which would allocate 3 percent to the 2024 Medicare conversion factor and update the threshold for implementing budget-neutral payment cuts in the Physician Fee Schedule. This bill would raise the budget neutrality threshold to $53 million and use cumulative MEI increases to update the threshold every five years afterward. ACP also supports provisions in the bill that would require CMS to update the direct costs associated with practice expenses (clinical labor, equipment prices, and medical supplies) simultaneously at least once every five years.

Here is a look at other areas of the fee schedule.

Clinical Labor Pricing

“ACP is pleased that CMS underwent a four-year transition period to update clinical labor pricing. This update is long overdue as wage rates are inadequate and do not reflect current labor rate information, creating distortions in the direct practice expense allocation,” Johnson said. “In the future, ACP encourages CMS to avoid decades-long gaps between clinical labor pricing updates and to partner with physician organizations to update cost data more frequently to improve compensation and protect the primary care workforce.”

New Codes for Advanced Primary Care Management Services

ACP is generally supportive of a proposal to create new codes for Advanced Primary Care Management services. These services offer the potential for a guaranteed income stream, upfront payments to help practices provide this care, increased support for primary care, and simple attribution policies.

“However, we have concerns about the proposed valuation for the three codes, the constraints of budget neutrality and its impact on utilization, proposed electronic medical records capabilities, utilization in Medicare Advantage, and patient copays,” Johnson said.

ACP recommends that CMS finalize the Advanced Primary Care Management services but delay implementation until calendar year 2026. This would allow interested parties to work with CMS to refine and enhance the services effectively, improving the care patients need and deserve and better settling the foundation upon which these services are provided.

Support of Primary Care

ACP is pleased that CMS recognizes the inherent complexity of primary and longitudinal care and strongly supports the proposal to refine the G2211 code.

“ACP supports CMS's many proposals to allow payment for the code in different scenarios, such as on the same day as an annual wellness visit, with vaccine administration or alongside any Medicare Part B preventive service,” Johnson said. “ACP has called on CMS to refine its policy to allow G2211 to be reported across all sites of service, including Home or Residence Evaluation and Management services that meet the requirements of the add-on code.”

ACP is concerned about the lack of coverage for the add-on code across private payers. Because these payers are not required to pay for services associated with G2211, coverage and policies vary considerably, creating frustration across the physician community and threatening access to these much-needed services.

Telehealth Flexibility

“ACP is pleased that CMS is revising its definition of telecommunications to include audio-only communications,” Johnson said. “We appreciate the flexibility and waivers that CMS has granted over the past few years and acknowledge how important telehealth is to reaching patients who cannot have traditional, in-office visits.”

ACP is especially encouraged by how audio-only technology can positively impact behavioral and mental health services among rural and underserved populations, as these populations are more likely to have access to audio-only technology than audio-video technology. “Physicians should continue to be empowered to determine when services can be furnished via audio-only formats,” Johnson said.

However, she added that “the College is greatly concerned that the statutory restrictions on geography, site of service, and clinician type in place before the COVID-19 public health emergency will go back into effect on Jan. 1, 2025, unless Congress acts.”

With these flexibilities set to expire, ACP is urging Congress to pass the following bills:

• The Connect for Health Act of 2023, which would permanently expand access to essential telehealth services, including expanding originating sites, lifting geographic requirements for telehealth services, and allowing Federally Qualified Health Centers and Rural Health Clinics to continue providing telehealth services.
• The Protecting Rural Telehealth Act and the Telehealth Modernization Act, which would ensure that seniors can continue accessing audio-only telehealth consults with their physicians after this option expires at the end of 2024.

“The College has submitted comments to the proposed rule, and we continue to engage with the agency, Congress, and other interested parties to drive structural change that will protect patients' access to care and support physicians,” Johnson said. “It is time that the physician community, federal regulatory agencies, and Congress come together to advance policies that strengthen the nation's primary care foundation and better position patients to access the care they need.”

The final fee schedule will be released in November.

Back to the September 27, 2024 issue of ACP Advocate