The current path is not sustainable. Congress has the opportunity to throw our physician practices a lifeline by passing H.R. 6683, the Preserving Seniors’ Access to Physicians Act. This bipartisan effort, championed by Rep. Greg Murphy, MD (R-NC), would eliminate the full 3.37% Medicare physician payment cut that went into effect in 2024. The FY2024 National Defense Authorization Act (NDAA) included an extension of the Medicare sequester that added $2.2 billion to the Medicare Improvement Fund—more than enough to offset an elimination of the 3.37% physician payment cut without adding to the federal deficit. H.R. 6683 is a step in the right direction; however, reformation of the current system is needed for long-term sustainability and protection of patient access to care.
Call for Change
Adjusting for inflation, Medicare physician payments plunged 20% from 2001 to 2021. During the same time, the cost of operating a practice went up 39%. Structural changes are needed to reform the current reimbursement system that requires a balanced budget, a system that is crushing physicians and contributing to the growing medical workforce crisis.4 Some changes championed by the ACR are:
- Ending the budget neutrality requirement for the Medicare Physician Fee Schedule (MPFS);
- Adding a permanent, Medical Economic Index (MEI)-based inflationary update to the MPFS, as laid out in the Strengthening Medicare for Patients and Providers Act (H.R. 2474); and
- Ending the statutory freeze on Medicare physician fee payments related to inflation, currently scheduled through 2025. Under the current model, physician payments are subject to a six-year payment freeze that ends in 2026. When the freeze ends, the statutory update for most physicians will be limited to 0.25% indefinitely, well below even normal inflation rates.
Despite the challenges and seemingly uphill battle facing the sustainability of the Medicare payment system, there are wins worth celebrating. For calendar year 2024, the Centers for Medicare and Medicaid Services (CMS) finalized a new add-on code, G2211. This code is for outpatient office visits to acknowledge the complexity of ongoing care of a patient’s singular chronic or complex condition, such as systemic lupus erythematosus, systemic sclerosis, vasculitis, rheumatoid arthritis or inflammatory myositis.
The ACR strongly supported the creation of G2211 and led advocacy efforts for its implementation to reimburse cognitive specialists more adequately for the services they are already providing. This new code is billed as an add-on to office/outpatient evaluation and management (E/M) visits. For more information, see the ACR’s Guide to Understanding the New Medicare G2211 Code.
