Capitol Hill Report: What could fix physician reimbursement?
November 11, 2024
Issue in focus
Update: The AAN is assessing the impact of last Tuesday's general election and will update members on the potential effect on neurology.
On Friday, November 1, the Centers for Medicare and Medicaid Services (CMS) released the final 2025 Medicare Physician Fee Schedule (MPFS). Right after the rule’s release, the 好色先生 (AAN) sent a summary of the rule and its impact on neurology to its members. As the summary outlines, the policies that are set by CMS are expected to have a 0% impact on payment for neurological care. However, absent Congressional intervention, there will be a 2.8% cut to physician reimbursement across the board in 2025.
This cut is the result of two factors: the requirement that the fee schedule be “budget neutral,” and the expiring relief to physician reimbursement from the Consolidated Appropriations Act of 2024 that addressed previous years’ cuts. When Congress first passed the legislation that set up our current Medicare physician reimbursement system, they implemented a budget neutrality requirement that forces CMS to make cuts to the fee schedule if they implement new codes or increase the value of existing codes. The statutory requirements that dictate how CMS can write the fee schedule have resulted in proposed cuts to physician payment for the last five years. In order to stabilize physician reimbursement and stop this never-ending cycle of cuts, Congress must act to address the structural problems in the MPFS.
The AAN has been working tirelessly to advocate for legislation that would fix the impending 2025 cut or bring long-term stability to the fee schedule:
H.R. 10073: The Medicare Patient Access and Practice Stabilization Act
This was recently introduced by Representative Greg Murphy (R-NC-3) and Representative Jimmy Panetta (D-CA-19) with original co-sponsors Representative Marianette Miller-Meeks (R-IA-1), Representative Ami Bera (D-CA-6), Representative Larry Bucshon (R-IN-8), Representative Raul Ruiz (D-CA-25), Representative John Joyce (R-PA-13), and Representative Kim Schrier (D-WA-8). The legislation would address the cut to physician reimbursement included in the fee schedule and, importantly, would increase reimbursement under the MPFS by a percentage of the Medicare Economic Index. This is the first time a piece of legislation aimed at addressing cuts to the fee schedule includes this inflationary update. This represents a huge step forward in the conversation on Capitol Hill and would not have happened without the dedicated advocacy of AAN members.
H.R. 2474: The Strengthening Medicare for Patients and Providers Act
This was introduced by Representative Raul Ruiz (D-CA-25) and Larry Bucshon (R-IN-8) and has broad bipartisan support with 170 co-sponsors. The legislation seeks to address an important structural issue with the MPFS—the fact that it is the only fee schedule without an automatic inflationary adjustment. If passed, CMS would be required to include an automatic inflationary update to the MPFS equivalent to the Medicare Economic Index. This adjustment would be outside of the budget neutrality requirements so would represent a built-in increase to reimbursement to help offset the current trend of built-in decreases to reimbursement. This bill has been a key part of AAN advocacy and has been an ask for the past two years at Neurology on the Hill.
S.4935/H.R. 6371: The Provider Reimbursement Stability Act
This bill was introduced by Senator John Boozman (R-AR) and Senator Peter Welch (D-VT) in the and Representative Greg Murphy (R-NC-3), Representative Brad Wenstrup (R-OH-2), and Representative Michael Burgess (R-TX-26) in the . This legislation addresses two of the structural issues surrounding the fee schedule’s budget neutrality requirement. First, it raises the dollar amount that triggers the budget neutrality requirement for the first time in several years. This would help decrease cuts resulting from small changes to the fee schedule. Second, it would allow for a “look back period” to account for cuts that resulted from an overestimate of utilization for a new code. When proposing a new code in the fee schedule, CMS must estimate how often a code will be utilized in order to comply with budget neutrality requirements. This estimate, especially in the past few fee schedules, has been drastically higher than actual uptake of the code. Currently, there is no way for CMS to claw back the money they cut from the fee schedule resulting from that overestimate. This bill would fix that and allow the funds to go back into the fee schedule to help offset cuts to reimbursement.
Make your voice heard
Congress will not act to fix the MPFS without hearing from constituents, which is why it’s so important you take part in the action alerts sent by the AAN. If you want to see the 2025 cuts fixed, right now and ask your representative to co-sponsor the Medicare Patient Access and Practice Stabilization Act.
The AAN will continue to advocate for you and your patients as the 118th Congress comes to a close. If you have any questions about our advocacy work, don’t hesitate to contact us at advocacy@aan.com.
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