CMS Proposed Fee Schedule

Proposed Rule for Medicare Physician Fee Schedule in CY 2024

The Centers for Medicare & Medicaid Services (CMS) has proposed changes to how doctors are paid through Medicare in 2024. The proposed rule would reduce the conversion factor, a key number used to calculate payments, by 3.34%. However, the rule also proposes to increase payments for primary care and other direct patient care services, as well as preventive services and telehealth services.

The proposed rule is intended to make Medicare payments more equitable and to encourage doctors to provide high-quality care. However, some doctors have expressed concerns that the lower conversion factor could lead to a decrease in their overall income.

Here is a more detailed breakdown of the proposed changes:

  • Conversion Factor: CMS is proposing to reduce the conversion factor by 3.34% in 2024. This reduction is due to a budget-neutrality requirement that requires CMS to make adjustments to the payment schedule to ensure that overall spending does not exceed certain targets.
  • Payments to Primary Care Doctors & Other Direct Care Providers: CMS is proposing to increase payments for these services by an average of 3.5%. This is intended to encourage more doctors to provide primary care and other direct patient care services.
  • Preventive Services: Additionally, CMS is suggesting payment increases for preventive services such as cancer screenings and vaccinations. This adjustment seeks to enhance the well-being of Medicare beneficiaries, ultimately reducing the necessity for costlier healthcare interventions in the future.
  • Telehealth Services: CMS is considering the inclusion of new services that can be delivered through virtual appointments, including health coaching. This expansion is intended to simplify access to care, particularly for beneficiaries residing in remote or underserved areas, as well as those facing challenges in traveling to in-person doctor appointments.
  • New Medicare Members: CMS is proposing to allow family therapists and mental health counselors to join Medicare and get paid for their services. The objective is to improve access to mental health care for Medicare beneficiaries.
  • Changes to MIPS: CMS is exploring ways to simplify doctors’ participation in the Merit-based Incentive Payment System (MIPS), which offers rewards for excellent performance. This initiative is geared towards motivating physicians to deliver high-quality healthcare services.

This rule is still in the proposal stage, and CMS will review public comments and make changes to the rule as needed before finalizing it in the fall. The new payment amounts would take effect on January 1, 2024.

Impact on Physicians & Patients

The proposed rule may have a varied impact on physicians. While the lower conversion factor might result in reduced overall payments, the additional funds allocated for primary care and direct patient care could potentially offset this. Additionally, the changes to MIPS could make it easier for physicians to earn performance bonuses.

Patients might also feel the effects of the proposed rule. Those who see family doctors might pay less, but those seeing specialists might pay more. Additionally, the expansion of telehealth services could make it easier for patients to access care, especially those who live in rural or underserved areas or who have difficulty traveling to see a doctor in person.

Overall, the proposed rule has both potential benefits and drawbacks for physicians and patients. It is important to note that the rule is still in the proposal stage, and CMS could make changes based on public feedback.