As was posted on Friday, CMS released its CY2024 proposed rules for physician fee schedule, ambulatory surgery center, and hospital outpatient prospective payment systems schedules. We provided you with our initial high-level summaries for each rule and highlights.
There is some good news, significant amounts of bad news, and potentially ugly news in this proposed fee schedule.
PHYSICIAN FEE SCHEDULE
Some Good News
The rule proposes to:
- Increase payments for Telehealth payment rates. At this point, we do not have the full information, nor do we know if it will affect any other services.
As usual, CMS is proposing to decrease the conversion factor for 2024 by 3.34% from the conversion factor for 2023, meaning that physician services will be paid less in 2024 than 2023. As you are aware, we are being paid less in 2023 compared to 2022. Consequently, this marks the second year in a row that CMS has proposed a decrease in physician reimbursement. Physician Payment proposed rule is scheduled to be published in the Federal Register on August 7, 2023, and comments are due by September 11, 2023. CMS released a rule overview fact sheet and official press release.
ADD POLICIES TO IMPLEMENT REQUIRED MANUFACTURER REFUNDS FOR DISCARDED DRUGS
As usual, it is quite probable that we will be facing a never-ending 2% sequester cut. Apart from this, there is also a potential for a possible 4% cut based on American Rescue Plan Act of 2021 for physicians. Overall, the ugly news is that we may be facing a 9.34%, OR IS IT 9.3434? not considering inflation, which results in a 15% increase in our costs to practice compared to 2021.
ASC AND HOPD PAYMENT SCHEDULE
The rule proposes to:
- Apply a payment update of 2.8%.
- Continue pass-through payment for certain drugs, biologicals, and pharmaceuticals.
- Continue nonopioid pain management drug and biological payment policies.
- Solicit comment on potential payment adjustment to mitigate future drug shortages and maintain access to essential medicines needed for acute patient care.
As in the past, there is 2% sequester cut on these payments neutralizing 2.8% increase to 0.8% increase. Continue 340B payments at average sales prices plus 6%.
In addition to the above 2% sequester cut, there may be a 4% American Rescue Plan Act of 2021 cut for ASCs. Overall, this will result in a 3.2% cut or if American Rescue Plan Act 4% cut is not implemented, it will result in a 0.8% increase, which does not keep up with inflation as shown above.
The proposed rule is scheduled to be published in the Federal Register on July 31, 2023, and comments are due by September 11, 2023. CMS has provided a rule overview fact sheet and a hospital price transparency and behavioral health fact sheet relating to proposals in this proposed rule. See the press release here.
We are further reviewing the rules and we will be preparing comment letters. We encourage all individuals to provide appropriate comment letters from physicians, staff, and patients. ASIPP’s site to send the letters will be activated. However, the personal letters will have the most important effect, specifically patient letters, and meeting with the members of Congress.
Please see sample of a proposed fee schedules: For the full fee schedules, go to ASIPP’s Members Only section of our website.