Without congressional action before the end of the year, Medicare providers are set to face up to a 10% reimbursement cut. The Association for Clinical Oncology (ASCO) encourages its members to contact their lawmakers and urge them to address the cuts now.
In addition to a 4.47% cut to the Medicare conversion factor in the 2023 Medicare Physician Fee Schedule (PFS) final rule, a 4% PAYGO cut is expected to begin on January 1, 2023, and a 2% Medicare sequestration cut went back into effect on July 1, 2022. Additionally, absent congressional action, the 5% bonus payments incentivizing participation in Advanced Alternative Payment Models (APMs) end this year.
These concerning cuts 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 physician reimbursement decreased by as much as 20% when adjusted for inflation.
ASCO responded to a Congressional request for information on implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) and Medicare physician payment reform. The letter urged Congress to work with medical groups, such as ASCO, on quality improvement efforts and value-based care models. It also reiterated the need for long-term financial stability and predictability in Medicare.
ASCO is working closely with the House of Medicine to urge Congress to take action to stop the cuts. As a result, House and Senate lawmakers have taken the following bipartisan steps:
- In the Senate, Senators Debbie Stabenow (D-MI) and John Barrasso (R-WY) sent a bipartisan letter with 44 other colleagues, urging Senate leadership to address the looming cuts. The letter underscores the impact of the proposed physician fee schedule conversion factor decrease and notes lawmakers’ commitments to enacting long-term payment reform which provides stability for providers.
- In the House, 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 legislation also includes language that says lawmakers and the Department of Health and Human Services should promote and reward value-based care, as well as safeguard timely access to high-quality care by advancing health equity and reducing disparities. ASCO and our State Affiliates endorsed the legislation in a joint letter to Congress.
Congress returned to session November 14, 2022, so now is the time to visit the ACT Network, and ask your lawmakers to address pending Medicare physician payment cuts before the end of the year.
Bookmark ASCO in Action for updates, as well as news, advocacy, and analysis on cancer policy.