The newest Congressional funding package includes legislation that reduces the latest cut to Medicare reimbursement. This bill language and the implementation of a new in-office payment this year have rheumatologists faring better under Medicare in 2024. However, broader reforms remain the ACR’s highest priority regarding Medicare payments to physicians.
A Partial Fix
The ACR called on Congress to reverse a 3.4% cut to the Medicare conversion factor that was implemented on Jan. 1. At the start of negotiations for this funding package, provisions on pharmacy benefit manager (PBM) transparency, prior authorization, step therapy and funding for graduate medical education were under discussion. All but two healthcare provisions fell by the wayside: funding community health centers and mitigating the most recent cut to physician payments to 1.68%.
This change represents a partial fix. However, Medicare payments to physicians plunged 20% from 2001 to 2021, while the cost of operating a practice went up 39%. Specifically, the Medicare conversion factor, one multiplier used to determine reimbursement of evaluation and management services relative value units (E/M RVUs), was $38.26 in 2001. If the conversion factor had kept pace with inflation, it would be $67.39 in 2024. The actual conversion factor in 2024 is $32.74—even lower than it was in 2001.
The current system creates annual winners and losers, even as all physicians suffer across-the-board cuts. The ACR’s advocacy efforts got rheumatology visits paid more in 2024. On Jan. 1, 2024, the Centers for Medicare & Medicaid Services finalized a new add-on code (G2211) for outpatient office visits that increases payment for the complexity of care rheumatologists provide. For more information, see the ACR’s Guide to Understanding the New Medicare G2211 Code.
Needed Medicare Reform
The ACR is fighting for changes to the Medicare reimbursement system to stop the bleeding, keep the value of rheumatology from diminishing further and build back adequate repayment for caring for Medicare patients. The current Medicare math works specifically against rheumatology by steadily devaluing medical care that occurs in the office each year.
The ACR urges Congress to repeal measures that prevent reimbursement from reflecting the modern economy. Repealing the following measures would help support and sustain private practices, increase the value of rheumatology to larger health systems and help our specialty attract new talent:
- Ending the budget neutrality requirement that requires any increase in Medicare physician payments for a code be paid for by a cut to other codes.
- Growing physician reimbursements with inflation each year, as Medicare does for hospitals and every other Medicare fee schedule.
