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Medicare Physician Reimbursement

January 12, 2024 11:14 AM | Katy Monaco (Administrator)

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The Background: 

A 3.37% Medicare physician payment cut took effect on January 1. Congress must take action immediately to address the cuts and reform the flawed Medicare physician payment system.

  • Physicians are the only providers who do not automatically receive an annual inflationary update from Medicare. Year after year, reimbursement for physicians falls drastically below inflationary rates, resulting in cuts to reimbursement for services.
  • The lack of annual adjustments in the Medicare Physician Fee Schedule (MPFS) due to budget neutrality requirements limit the allocation of funds for essential cancer care services.
  • The increased Merit-Based Incentive Payment System (MIPS) Performance Threshold would lead to half of MIPS eligible clinicians receiving a negative payment adjustment for the 2024 performance period and would further disadvantage smaller practices.
  • The lack of incentives and financial stability hinder the broader transition to value-based care models.

Why it Matters: 

The Medicare reimbursement system makes it difficult for physicians to maintain a viable business, impacting patients’ access to care. Physician reimbursement has fallen behind inflationary rates by 26% since 2001. Along with increased performance thresholds, the limitations on resources allocated for necessary care, and the lack of incentives to transition to value-based care models, only amplify the unsustainable Medicare physician payment system.

The Ask:

Join ASCO in asking Congress to address the 3.37% Medicare physician payment cut that took effect January 1 and take the following steps to improve the flawed Medicare physician payment system and improve financial stability for practices. Specifically, we ask Congress to:

  • Provide automatic inflationary updates to reimbursement.
  • Eliminate budget neutrality requirements.
  • Make meaningful changes to the Merit-Based Incentive Payment System (MIPS).
  • Incentivize the transition to value-based care.

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