Hill Day Issues 2025
Medicare Physician Practice Payment Reform
-
Since 2020, an ACR-led coalition of organizations representing over one million physician and non-physician providers lobbied Congress to provide short and long-term relief for the Medicare Physician Fee Schedule (MPFS) to mitigate significant payment reductions resulting from the statutorily required application of budget neutrality.
-
Most recently, Congress added an additional 2.93% to the Medicare Physician Fee Schedule (MPFS) conversion factor (CF) which expired at the end of 2024. Congress has not intervened for 2025 and as a result, the current MPFS CF is roughly 2.83% below the 2024 CF.
-
As one of the only fee schedules without a built-in inflationary update, MPFS payment rates struggle to keep pace with the true cost of maintaining a practice. The addition of a Medicare Economic Index (MEI) based inflationary update to the MPFS will help provide long term financial stability to Medicare providers thereby helping ensure Medicare beneficiaries get the care they deserve.
Your Ask
-
Congress needs to take initial steps now to address the broken Medicare physician practice payment system by adding an annual payment adjustment based on the Medicare Economic Index (MEI) and reform the budget neutrality requirements which have caused significant problems for the Medicare physician payment system.
-
Consider using the savings associated with the ROOT Act to offset the cost of permanent Medicare physician practice payment reform.
Radiology Outpatient Ordering Transmission (ROOT) Act
-
As part of the Protecting Access to Medicare Act of 2014 (PAMA), Congress established the consultation of physician-developed appropriate use criteria (AUC) by providers ordering advanced diagnostic imaging exams.
-
Implementation of the PAMA AUC program is designed to:
-
Provide the patient with the appropriate exam the first time
-
Curb patient exposure to unnecessary radiation
-
Reduce Medicare spending on low-value imaging
-
Promote the movement towards value-based imaging care and physician-developed guidelines
-
While CMS reinforced the benefits of the program, it has indefinitely “paused” implementation of the AUC program due to certain claims processing challenges.
|
