In a step towards addressing one of multiple pending Medicare physician payment cuts, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the Supporting Medicare Providers Act (H.R. 8800), which would increase the conversion factor to 4.42%, effectively putting the Medicare physician fee schedule (PFS) cut on hold for a year. The new legislation also includes language that says lawmakers and the Department of Health and Human Services (HHS) should work to promote and reward value-based care, as well as safeguard timely access to high-quality care by advancing health equity and reducing disparities. The Association for Clinical Oncology (ASCO) supports this effort to provide short-term stability and urges Congress to pass the bill before the end of the year.
In addition to the conversion factor cut in the 2023 PFS proposed rule, the 2% sequestration cut went back into effect on July 1, 2022, and a 4% pay-as-you-go (PAYGO) cut looms on January 1, 2023. Additionally, the Medicare Access and CHIP Reauthorization Act included 5% bonus payments to incentivize participation in Advanced Alternative Payment Models (APMs), including the Oncology Care Model (OCM). OCM ended in June 2022 and will be replaced with the Enhancing Oncology Model (EOM) in June 2023. As a result, there will be a gap year between the expiration of the bonus payments under OCM and the restart of modest annual fee schedule updates under EOM. Absent Congressional action, this will result in the loss of another 5% in reimbursement for some practices and disincentivize APM participation, potentially jeopardizing the long-term sustainability of APMs.
ASCO is very concerned that these cuts will jeopardize patient access to care, since they come as practices, hospitals, and other stakeholders face ongoing uncertainty about pandemic recovery, historically high inflation, staffing shortages, and growing administrative burden. From 2001 to 2021, Medicare reimbursement for physicians decreased by as much as 20% when adjusted for inflation.
ASCO recently joined the American Medical Association (AMA) and over a hundred organizations in sending a letter to House and Senate leaders urging them to act before the end of the year to address the cuts. ASCO also joined the entire House of Medicine to endorse the Supporting Medicare Providers Act.
Contact your Members of Congress using the ACT Network and urge them to:
- Provide a 4.42% conversion factor adjustment for the PFS for 2023 by passing the Supporting Medicare Providers Act (H.R. 8800)
- Waive the 4% statutory PAYGO requirement
- Provide a one-year inflationary update based on the Medicare Economic Index (MEI)
- Eliminate the 2% sequestration cut to Medicare
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