These cuts will likely continue. The 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System sets the physician fee schedule conversion factor for 2025 at $32.35, down from $33.29 in 2024.
Eugenio Hernandez, MD, chief medical officer of Miami-based Gastro Health, joined Becker’s to discuss how reimbursement challenges are affecting GI practices and ASCs.
Editor’s note: This interview was edited lightly for clarity and length.
Question: What are the biggest regulatory or reimbursement challenges currently facing gastroenterology practices and ASCs?
Dr. Eugenio Hernandez: Physicians have been behind the curve in terms of inflation with respect to Medicare fee schedules. Most years, it’s not about getting an increase — it’s about mitigating expected cuts. That’s the yearly battle we face, whereas hospitals, PBMs and other strategics don’t experience that pressure. If you look at healthcare as a whole, they are always above the inflationary curve, while physicians are underneath it.
We can’t simply increase the price of our services, yet we face the same labor cost pressures as everyone else. We must pay our staff, cover insurance, and handle rising operational costs, yet reimbursement rates continue to decline. That is by far our most significant challenge. Fortunately, we are active in medical associations and advocacy groups to mitigate these issues, but it remains a constant struggle.
Another major challenge is dealing with prior authorizations. There was a lot of news recently about United [Healthcare] and the difficulties they created for physicians and patients. These issues require significant time and energy, adding strain to an already stretched workforce.
From a regulatory standpoint, we never know what changes will come next. For example, the FTC recently proposed banning noncompete clauses, then modified their stance. As physicians, we can’t compete financially with the lobby groups that hospitals and PBMs employ. The best we can do is advocate for ourselves and, more importantly, for our patients, as they are the ones most impacted.
