In November, CMS announced plans to reduce overall physician pay by 1.25% in 2024 and update the conversion factor to $32.74, a 3.4% decrease over last year, much to the chagrin of physicians and ASC leaders alike.
Organizations and leaders, including the American Medical Association president, have issued statements criticizing the decision, noting that the Medicare Economic Index, which measures medical practice cost inflation, increased 4.6%, the highest in the last 23 years.
Physicians, including orthopedic surgeon Adam Bruggeman, MD, are prioritizing fixing the payment system in 2024, meeting with legislators in Washington, D.C., to address reform options.
"My top priority is working toward a permanent fix to the Medicare physician payment system. We have gained significant momentum and awareness on the topic in Washington, D.C., and recently had the chair of the Senate Finance Committee state that their committee would need to address the issue next year," he told Becker's. "Meaningful reform with a tie to the actual cost of providing care is needed to ensure access for patients and the long term viability of physician practice."
Additionally, surgeons are working with external compensation organizations and considering cutting ties with Medicare altogether.
"I'm planning to improve my payer mix by networking with workers' compensation nursing organizations. I also am limiting the number of Medicare patients seen on a daily basis," Timothy Lubenow, MD, professor of anesthesia and pain medicine at Chicago-based Rush University Medical Center, told Becker's.
Ara Deukmedjian, MD, CEO and surgeon of the Deuk Spine Institute in Melbourne, Fla., already made the decision to opt out of all Medicare plans and has not regretted it.
"I have been much happier. I see fewer Medicare patients, but for the ones I operate on, I feel that I get paid much better and I get compensated fairly. My practice has thrived. I'm doing better now financially than ever before. I don't have a threat of worrying about whether the Department of Justice is going to come after me for accidentally coding a level three when it should be a level two or vice versa," he told Becker's.
CMS' payment rule for ASCs is slightly different than the rate for hospitals, coming in at 3.1%. Even with the improved rate, physicians feel as though ASC payments still are not fair under Medicare.
"With the inflationary curve on the rise and another looming cut to the physician fee schedule, it is imperative that we re-examine our payer contracts with all other payers in our market. Many of the Medicare Advantage plans in our market are trying to pay below the Medicare physician fee schedule, and none of them are accounting for the implant costs associated with doing surgery in our ASC," Andrew Lovewell, CEO at Columbia (Mo.) Orthopaedic Group, told Becker's. "I am also looking for steerage from the payers for ASC strategies in our market. As the low cost/high value provider in the market, we should see significant streerage to our facility but have not experienced that yet. With our clinical outcomes both surgically and non-operatively, we are the best value around."
CMS also added 11 new procedures to its ASC-covered list for 2024, including several orthopedic procedures. Some surgeons still believe that it isn't enough and plan to prioritize encouraging Medicare to continue adding to the list.
"I would like to see insurers including Medicare allow surgeries that can be done in ASCs to be done there. All too often I find our group doing surgeries in a hospital at three or four times the expense that easily could be done in an ASC. The insurers would save a lot of money, and the patients would have a much better experience," Ken Rich, MD, president at Raleigh (N.C.) Neurosurgical Clinic, told Becker's.
Heading into 2024, physicians and interest groups alike plan to continue standing up to ongoing Medicare pay cuts, and even bucking traditional CMS payment and reimbursement models to keep their practices financially sustainable.