ASCO, along with more than 100 medical organizations and societies, sent a letter to members of the U.S. House and Senate leadership urging Congress to prioritize and advance several bills and legislative proposals that would provide greater fiscal stability for physicians and reform key elements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The letter, sent to Congress on July 24, 2024, was in response to the July 10th release of the Centers for Medicare & Medicaid Services (CMS) 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, which calls for an additional payment reduction of 2.8% to take effect on January 1, 2025. That cut would follow a 1.68% decrease that took place in 2024.
“This latest inexcusable cut looms, despite the fact that CMS also projects the increase to the MEI [Medicare Economic Index] to be 3.6% in 2025, thus confirming that inflationary costs associated with running a practice continue to rise. This series of annual payment reductions and the lack of an inflationary update continue to threaten the viability of physician practices, add considerable burden to the practice of medicine, and stifle innovation,” wrote the organizations’ signees.
Reforming Medicare Physician Payment Programs
The letter calls on Congress to strengthen the current payment system by refining the MPFS to accurately reflect the fiscal and clinical realities of medical practice today, and focuses on four key areas of reform:
Enacting an annual, permanent inflationary payment update in Medicare that is tied to the MEI.
- Establishing budget neutrality reforms, including enacting the Provider Reimbursement Stability Act, H.R. 6371. The bill would reform the Medicare physician payment schedule budget neutrality policies by raising the threshold that triggers a budget neutrality adjustment from $20 million to $53 million, and increase it every 5 years by the cumulative increase in the MEI.
- Overhauling MACRA’s Merit-based Incentive Payment System, and replacing key elements of the program this year with a Data-Driven Performance Payment System that freezes performance thresholds for 3 years to allow recovery from the COVID-19 pandemic and the Change Healthcare cyberattack; eliminates the current tournament model and replaces corresponding payment penalties of up to 9% with payment adjustments assessed as a percentage of statutorily mandated payment updates (ie, 0.25% or MEI); ensures that CMS provides at least three-quarters of claims feedback reports, and exempts physicians from all penalties should the Agency fail to provide this data; and aligns program requirements with other CMS hospital value-based programs, simplifies reporting by allowing cross category credit, and enhances measurement accuracy.
- Modifying Alternative Payment Models (APMs). In the letter, the organizations asked Congress to advance the S.3503 Value in Health Care Act of 2023, a bipartisan bill that extends the original 5% APM incentive payments and freezes the 50% revenue threshold for an additional 2 years. Current APM bonuses expire at the end of 2024, and the 50% revenue threshold is scheduled to increase to a “nearly impossible-to-reach 75% on January 1, 2025,” according to the letter to Congressional leaders. In addition, the organizations asked that CMS and the Center for Medicare and Medicaid Innovation develop a robust pipeline of APMs that are available to all physicians, especially specialists and those practicing in rural areas of the country.
Call to Action
“We stand ready to work with Congress to implement these critical legislative reforms to ensure a sustainable and effective Medicare physician payment system. We urge lawmakers to heed this call by working together and acting quickly to preserve access to care in the Medicare program,” concluded the letter.
ASCO is asking members to add their voice to these important reforms to the 2025 MPFS proposed rule by sending their lawmakers a message through ASCO’s ACT Network.
