The finalized calendar year 2025 Medicare physician fee schedule, which the Centers for Medicare & Medicaid Services (CMS) released on Nov. 1, is sparking considerable protests from national associations representing physicians and other providers .
In a press release posted on the agency’s website on Fridaythe agency noted that, “Due to factors specified in the law, average payment rates under the PFS will be reduced by 2.93% in fiscal year 2025, compared to the average amount paid for these services during the majority.” part of fiscal year 2024. The change in the PFS conversion factor incorporates the general 0% update required by statute, the expiration of the temporary 2.93 percent increase in payment for fiscal year 2024 required by statute and a relatively small estimated adjustment of 0.02 percent needed to account for changes in relative labor value units (RVUs). ) for some services. This is equivalent to an estimated FY 2025 PFS conversion factor of $32.35, a decrease of $0.94 (or 2.83%) from the current FY 2024 conversion factor of $33.29.”
The agency noted that “the calendar year 2025 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in improved accessibility, quality, affordability, empowerment and innovation for all Medicare. beneficiaries.”
But all major national provider associations issued a largely negative assessment on Friday, November 1.
The leaders of APG, America’s Medical Groups based in Washington, DC, issued a press release on Friday with a statement that began: “The publication of the Medicare Physician Fee Schedule (MPFS) final rule today leaves in place the proposed cuts to medical fees for 2025 and, in fact, raises them slightly higher, to 2, 93 percent, as a result of other changes in the rate schedule. “We are disappointed,” said Susan Dentzer, president and CEO of America’s Physician Groups. ‘Any action to mitigate the crippling effect of the rate cuts will now be the responsibility of Congress.’”
The association’s statement went on to note that, “As widely reported, inflation-adjusted Medicare physician fees have fallen 29 percent since 2001 due to fee schedule changes and the lack of a comprehensive inflation update.” of medical practice. APG looks forward to working with congressional policymakers in the coming weeks and months to shape plans to moderate the proposed rate cut and, ideally, eliminate it entirely. Other aspects of the MPFS final rule are much more favorable to physician practices and APG member organizations,” APG noted, quoting Dentzer as saying that “we welcome measures such as allowing eligible Accountable Care Organizations (ACOs) to with a track record of success in the Medicare Shared Savings Program, which includes many of our member groups, to receive advances on their earned shared savings.” Also beneficial will be “new coding and payment policies for advanced primary care management services, which, as CMS noted, will provide a new path toward accountable care built into the fee schedule and help increase the number of more physician practices.” “small ones committed to value.” based care,” the association stated.
Leaders of the Alexandria, Virginia-based organization AMGA (American Medical Group Association) He also expressed his disappointment. The association’s statement was published as a press release posted on their website on Friday. It began: “AMGA today objected to an imminent 2.83 percent cut in the Medicare conversion factor,” AMGA’s statement began. “As finalized in the 2025 Medicare Physician Fee Schedule, the cut may force AMGA members to lay off staff and physicians, further exacerbating patient access to care; not accepting new Medicare beneficiaries as patients; and delay investments in social drivers of health,” AMGA stated in a press release on Friday.
“Despite a projected 3.6 percent increase in the Medicare Economic Index, which measures inflation in medical practice costs, the Centers for Medicare & Medicaid Services (CMS) finalized the 2.83 percent cut. percent in the Medicare conversion factor,” the statement continued. “This cut demonstrates flaws in the way Medicare reimburses Part B care and services. Specifically, the lack of an inflationary update to Part B reimbursement creates an untenable situation for AMGA members, who face a fifth consecutive year of lowest Medicare reimbursement for physician and other clinical services.”
And AMGA quoted its president and CEO, Dr. Jerry Penso, stating that “Our member survey paints a pretty bleak picture. “If Congress does not stabilize reimbursement, our members will be forced to take further actions that will impact patient care.” Based on that perspective, the association said, “AMGA recently surveyed its members about what actions these Medicare cuts have forced them to take this year and what actions they will take in the future. For example, 45 percent of respondents reported that they will be forced to furlough non-clinical staff. But layoffs may be higher, with 31 percent indicating clinical staff layoffs would be necessary. These layoffs will have an effect on access to care, as 27% said they would not accept new Medicare beneficiaries as patients. The survey is available on the AMGA website.
“Five years of cuts to Medicare are going to catch up to us,” Penso said. “To keep the doors open, AMGA members will need to cut staff and reduce access to care for Medicare patients. The only real question is whether Congress will come together to prevent this.” And AMGA added that “now that CMS has finalized this cut, Congress must act to prevent it from taking effect on January 1, 2025.”
The leaders in MGMA, the Medical Group Management Association based in Englewood, Coloradoissued the following statement: “CMS and Congress have once again overlooked the sobering financial realities facing our nation’s medical practices, finalizing a 2.83% reduction to the Medicare conversion factor by 2025, increasing further the gap between practice expenses and reimbursement rates. Today’s final rule calls into question the financial viability of medical practices and threatens beneficiaries’ access to care. On a positive note, we are pleased that CMS heeded our call to finalize numerous telehealth policies, such as permanently covering audio-only services and expanding flexibilities for direct supervision and home reporting of practitioners. Congress should immediately return from recess to pass HR 10073, avoiding the 2025 cut to the conversion factor and stabilizing physician practices until a more permanent and sustainable solution to the Medicare physician payment system can be achieved.”
Meanwhile, NAACOS, the National Association of ACOs based in Washington, DCthe national association representing accountable care organizations, issued a statement Friday, attributed to Aisha Pittman, its senior vice president of government affairs. “The National Association of ACOs (NAACOS) commends CMS for its continued efforts to support ACOs by finalizing policies that protect against significant and unusual billing anomalies, thereby fostering long-term stability and certainty for ACOs,” Pittman said . “We are encouraged by CMS’s commitment to advancing the Medicare Shared Savings Program, particularly by reducing the reporting burden on beneficiaries, offering prepaid savings for successful ACOs, incorporating upward benchmark adjustments for ACOs serving to rural and underserved populations, and establishing billing for advanced primary care. .”
Additionally, Pittman’s statement continued: “While we welcome these developments, we remain concerned about unresolved issues that threaten the ACO’s participation in the Shared Savings Program. Historically successful ACOs face shrinking financial goals over time. Current policies fail to adequately account for past success, leaving ACOs unable to sustain robust clinical interventions and improved beneficiary benefits. Additionally, new quality reporting requirements will require costly investments in technology without producing actionable quality data. These challenges discourage physician participation in ACOs and hamper progress toward CMS’s goal of having all Medicare payments in an accountable care relationship by 2030.”
and leaders in Charlotte-based Premier Inc. also issued a statement attributed to Soumi Sahasenior vice president of public affairs for the alliance, posted on Premier’s website on Friday. In it, Saha said that “the Prime Minister is deeply disappointed that the Centers for Medicare and Medicaid Services (CMS) latest updates to the calendar year (CY) 2025 payment rules will further widen the gap between reimbursements of Medicare and the actual operating costs of healthcare providers. shoulder daily. Providers are grappling with rising inflation, labor shortages, and the demands of an aging population—challenges that CMS is failing to adequately address. This update misses the mark by failing to recognize the real cost pressures faced by suppliers, particularly labor. It is time for CMS to adopt more realistic methodologies and data sources to keep up with these growing challenges. If CMS continues to implement payment updates of this nature, the future of American healthcare will be in jeopardy,” Saha said.
