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Medicare Fee Schedule a Mixed Bag for 2023

By Emma Freer

Originally published by Texas Medical Association on December 7, 2022.

The Centers for Medicare & Medicaid Services (CMS) recently posted the 2023 Medicare Physician Fee Schedule, which takes effect Jan. 1 and brings with it a mixed bag of consequences for physicians.

The Texas Medical Association continues to fight certain elements of the final rule, including a nearly 4.5% physician pay cut and additional changes to the already-byzantine Merit-Based Incentive Payment System (MIPS). But the association also celebrates the victories in the regulation, including expanded cancer coverage and reduced administrative requirements.

TMA experts discuss the key updates from the final rule in the new, on-demand 2023 Medicare Update webinar. It is free to TMA members, and you can earn 1 AMA PRA Category 1 Credits™ that may count as ethics credit. 

A physician paycut and other concerns

The 2023 fee schedule lowers the conversion factor that determines physician payments by 4.47% compared with the 2022 formula, leaving many physicians concerned about their bottom line. Barring intervention by Congress, the cut would be one of many to take effect next year, including a sequester cut and other reductions mandated by law, totaling 8.5%.

Robert Bennett, TMA vice president of medical economics, is hopeful Congress will act to avert the cuts, but he cautions lawmakers could wait until January to do so retroactively.

“There are so many issues being debated in Washington, D.C. right now,” he said during the event. “I’m worried this is a back-burner issue for them.”

TMA urges members physicians to download its Medicare Payment Cuts Toolkit, which outlines ways to press lawmakers to intervene.

In the meantime, TMA joined the American Medical Association and others in organized medicine in writing to Congressional leadership on Dec. 1.

“Put simply, the cost of Congressional inaction is an across-the-board cut that will further amplify the financial hardship physician practices are already facing while inhibiting Medicare from delivering on its promises to seniors and future generations,” the signatories wrote.

TMA also has joined forces with AMA and scores of state and specialty medical societies to push for comprehensive Medicare physician payment reform. Such a long-term fix would prevent the need for physicians to lobby their representatives multiple times a year about impending pay cuts – or risk their practice viability.

As in previous years, the fee schedule also includes changes to MIPS, one of two pathways under Medicare’s Quality Payment Program. CMS says the changes focus on MIPS Value Pathways (MVPs) – a new, optional reporting framework set to debut in the 2023 performance year – and limit adjustments to traditional MIPS in an effort to spur participation in MVPs.

TMA has repeatedly asked CMS to reconsider MVPs and to focus instead on the development of voluntary, physician-led alternative payment models (APMs). Still, Mr. Bennett encouraged physicians who participate in MIPS to consider MVPs, which he said function as a hybrid between fee-for-service MIPS and value-based care APMs.

CMS is hosting a webinar on Dec. 14 from 1-2 pm CT about MVPs, including its rollout and how physicians can submit an MVP candidate for consideration. You can register for the virtual event via Zoom.

Fee schedule gains

Despite these concerns, the 2023 fee schedule includes meaningful gains when it comes to the Medicare Shared Shavings Program (MSSP), evaluation and management (E/M) coding and payment, certain pandemic-era flexibilities, electronic prescribing of controlled substances, and colorectal cancer screening. 

TMA welcomes some of the changes to MSSP, which its experts say could reduce barriers to participation. For instance, CMS will make advanced investment payments available to certain new accountable care organizations, which they could use to purchase the technology and data management resources and to hire the care coordinators necessary to participate in the program.

At the same time, TMA has asked CMS to consider phasing in – and even limiting – recoupment of any advance funding to encourage long-term participation as well as providing new opportunities to engage specialists in Medicare’s value-based programs.

CMS also will institute significant changes to E/M coding in the new year, heeding recommendations from TMA and AMA. These include simplified documentation requirements and increased payment for services provided at several sites, including hospitals, emergency departments, nursing homes, and patient’s homes.

Although this is a positive development, Mr. Bennett said these payment increases contributed to the 4.47% reduction in the conversion factor, given federal budget neutrality requirements.

CMS also delayed the implementation of a confusing policy related to split (or shared) visits, which determines who should bill for a shared visit. The fee schedule maintains the existing guidelines, and CMS will revisit the issue in its 2024 fee schedule.

In addition, the 2023 fee schedule offers some guidance on telehealth coverage once the federal public health emergency (PHE) related to COVID-19 ends. With it, CMS has extended certain telehealth flexibilities for 151 days after the PHE ends, including allowing:

  • Practices to use non-HIPAA complaint telehealth platforms; and
  • Medicare patients to access telehealth services anywhere, including at home, and via audio-only options, among other changes.

This aligns with Congress’ action in March, when it passed a spending package extending these same flexibilities for 151 days after the PHE ends.

Shannon Vogel, TMA associate vice president of health information technology, said physicians should anticipate making changes once the PHE and the 151-day grace period end, such as phasing out non-HIPAA compliant telehealth platforms and audio-only telehealth services. But she added that they still have time to do so.

“At this point, we feel pretty confident that the PHE will probably extend through about mid-April or so,” she said, which would put the end of the grace period in mid-September.

The PHE is currently slated to expire in January. However, the federal government has said it will give states 60-days’ notice of its end, a deadline that came and went in mid-November. Although the government hasn’t announced a new deadline, it previously has extended the emergency declaration in 90-day increments.

As recommended by TMA and others in organized medicine, CMS will delay until 2025 financial penalties for physicians who don’t electronically prescribe controlled substances. Although TMA supports this move, it has pushed CMS to go further by scrapping such penalties altogether, especially for those practices that do not do high volume e-prescribing.

Starting next year, Medicare patients also will benefit from expanded coverage of colorectal cancer screening tests, following advocacy by TMA and others in organized medicine. CMS gradually will reduce coinsurance payments for Medicare patients who undergo unplanned colorectal screening tests until 2030, when the federal agency will waive such copayments altogether.

TMA endorsed this policy change in its comment letter, writing that it would “reduce the financial burden facing Medicare [patients] whose screenings result in a diagnostic procedure” as well as “promote utilization of colorectal cancer screenings that save lives.”

TCU Medical Student Receives Award for Advocacy Work with AMA

By Prescotte Stokes III

Published by TCU School of Medicine on May 17, 2022. You can find the original here.

 TCU School of Medicine student Anand Singh received the New Member Outstanding Involvement Award in AMA-MSS Region 3 by the American Medical Association – Medical Student Section.

In his role as the Co-Advocacy Chair of AMA-MSS Region 3 that includes medical schools in Arkansas, Kansas, Louisiana, Mississippi, Oklahoma and Texas, the first-year medical student has helped organize nationwide campaigns for the organization.

“I was extremely honored to receive this award alongside other incredible leaders in AMA-MSS Region 3,” Singh said. “Receiving this award inspires me to continue growing my involvement in the AMA-MSS and be an advocate for medical students, physicians, and patients.”

Singh has been a part of the MSS Region 3 Resolution Review Committee, the Logistics and Resources committee for the AMA-MSS N-21 Conference and the Committee on Legislation and Advocacy (COLA) since 2021. He was also one of the authors on four different resolutions presented at the AMA N-21 Conference held in November 2021.

“Through the Texas Medical Association (TMA)-MSS, I was part of the Ad-Hoc Committee to review resolutions for TexMed 2022 and I was primary author for one resolution and helped draft two other resolutions,” Singh said.

Singh is the current AMA delegate for the TCU School of Medicine. During National Advocacy week in October 2021, he helped organize a “Call Your Rep” event as well as social events to increase AMA engagement at the medical school. He also attends monthly Tarrant County Medical Society meetings to provide updates about the medical school, the AMA-MSS and TMA-MSS chapters he’s involved in.

“It really gives me the opportunity to connect and build relationships with local physicians in Fort Worth and all across North Texas,” said Singh. “I believe that there is power in a collective voice and organized medicine provides medical students and physicians the opportunity to advocate for change on a local, regional, and national level. This motivates me to work harder and give back by mentoring other students to find their voice through the AMA-MSS on healthcare advocacy topics they are passionate about.”

HRSA Reopens Reporting Time for Period 1 Provider Relief Fund Recipients

Due largely to AMA and specialty society advocacy, the Health Resources and Services Administration (HRSA) has decided to reopen the reporting time for recipients of Period 1 Provider Relief Funds.

Those physicians who received more than $10,000 in provider relief funds and failed to submit their period 1 report should act immediately. Between Monday, April 11 and Friday, April 22, 2022, at 11:59 pm ET, physicians who have not submitted their Period 1 report may submit a late Reporting Period 1 report request. Physician practices should receive information about how to submit a request directly from HRSA via email.

If a physician did not submit a Period 1 report and does not hear from HRSA, they may initiate communication by calling (866) 569-3522. During this reopening period, the physician must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. While attesting to an extenuating circumstance is required, no supporting document or proof is required.

If HRSA approves the extenuated circumstances form, the physician will receive a notification to proceed with completing the Reporting Period 1 report shortly thereafter. They will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal. 

AMA Toolkit Dissects Federal Surprise Billing Law

By Joey Berlin

Originally published by the Texas Medical Association on March 10, 20202.

Much of the federal government’s solution to resolve certain out-of-network billing disputes without balance billing or otherwise involving patients – known as the No Surprises Act – took effect at the start of 2022.

Among other pieces physicians must familiarize themselves with, the new federal law features an independent dispute resolution (IDR) process that was intended to let physicians and insurers both make their case for fair payment. Naturally, plenty of minutiae and arcana exists within the law, and a portion of the rules for the IDR process is under a legal challenge from the Texas Medical Association and others in organized medicine.

To help physician practices understand and navigate the new law, the American Medical Association has created a toolkit, Preparing for Implementation of the No Surprises Act. The 20-page toolkit includes information on:

  • Operational challenges physicians “will need to address immediately” to be compliant with the law’s new requirements, such as when uninsured and self-pay patients must receive a good-faith estimate of charges before they receive services;
  • What services and care fall under the rules of the No Surprises Act;
  • Timetables and requirements for the IDR process; and
  • When and how facilities and physician practices can obtain a patient’s consent to balance bill for out-of-network care at an in-network facility.

AMA says it will update the toolkit “as additional guidance is available” and will develop new resources on parts of the law not already included in the toolkit.

For additional information on the No Surprises Act, you can check out TMA’s list of resources on the law, which has both similarities and differences to Texas’ IDR law governing state-regulated health plans.

Meanwhile, TMA and others are still pushing to ensure the implementation of the law is fair for physicians seeking to get paid. In late October 2021, TMA filed suit to challenge what physicians and hospitals say is an unfair piece of the IDR process outlined in federal rules. Check future editions of Texas Medicine Today for updates on that lawsuit.

TCU Medical Student and TMA/TCMS Member Anand Singh Elected to AMA Student Board

By Prescotte Stokes III

Read the original article here.

The American Medical Association-Medical Student Section (AMA-MSS) Region 3 executive board recently elected Anand Singh, a first-year medical student at TCU School of Medicine to serve as the Co-Advocacy Chair.

The AMA-MSS Region 3 includes medical schools in Arkansas, Kansas, Louisiana, Mississippi, Oklahoma and Texas.

“My job is to learn about what different health care policies are being passed in these different states,” Singh said. “And spread that news and raise awareness among medical students because as we all know these policies impact everyone from students to physicians and patients.”

Singh will oversee the Region 3 advocacy committee and lead advocacy initiatives to engage region chapters.

He will also work with the Advocacy Subcommittee of the Committee on Legislation and Advocacy (COLA) to help our region engage with events like National Advocacy Week (NAW) and the Medical Student Advocacy Conference (MAC). He will also support the Membership Chair and Secretary in reaching out to local chapters to highlight advocacy endeavors and provide advocacy updates in AMA-MSS Region 3 monthly newsletters.

“Policy writing is very niche and not every physician has to do that but the way this connects with the medical school is how they teach us to be an advocate for your patients,” Singh said. “And growing that idea on a larger scale its advocating for your population. Not only talking to physicians you’re talking to legislative members, congress members and kind of impact a larger audience that’s a really great opportunity as future physicians.”

The Medical Student Section (MSS) aims to be a voice for medical students’ across the AMA to help improve medical education and advocating for the future of medicine.

AMA President Joins TMAF Gala as Honorary Chair

Susan Rudd Bailey, MD, TMA past president and current American Medical Association president, will serve as honorary chair of the TMA Foundation’s virtual gala, Superheroes: Meeting the Challenge, which is scheduled for Friday, May 14, 2021, during TexMed 2021, TMA’s annual meeting. The gala helps make TMA’s population health, science, and quality of care programs possible.

“Clearly the COVID-19 pandemic has called on physicians like no other threat has in our lifetimes,” Dr. Bailey said. “It’s with great pleasure that I join the TMA Foundation gala to recognize and celebrate the courage physicians have shown because of their singular dedication to the health of their patients.”

Dr. Bailey is an allergist in private practice and has been with Fort Worth Allergy and Asthma Associates for more than 30 years. She has a long history of service in organized medicine, having served as TMA vice speaker and speaker and as board chair and president of the Tarrant County Medical Society.

“Please join me, the gala-co-chairs, and the TMAF board by attending this virtual gala, which comes at a time when we need to remain strong and follow where the science leads us. The continued strength and resolve of our physician heroes is needed to see us to the very end of this pandemic,” Dr. Bailey added.

TMAF’s gala will take place as a virtual event from 7 to 8:15 pm (CT) Friday, May 14, with a preshow from 6:30 to 7 pm. It will feature a silent auction, special messages to the health care superheroes in Texas, entertainment from Austin musicians, a party Box for guests and more.

 Purchase your table or tickets  or call (800) 880-1330, ext. 1664, or (512) 370-1664 today for more intormation.

Reimagining the Future of Medicine in a Post-COVID World

by Susan Bailey, MD – AMA President

This piece was originally published in the January/February issue of the Tarrant County Physician. You can read find the full magazine here.

Dr. Bailey presented this speech at the AMA’s House of Delegates on November 13, 2020.

In my inaugural address to the AMA House of Delegates in June, I talked about how a hero’s journey is symbolic of the journey we walk as physicians. 

Our journey starts with a moment of inspiration to pursue Medicine. We find a mentor to show us the way. We encounter struggles and hardships before emerging stronger and more resilient . . .  forever changed by the experience.

Few times in history have we embodied the hero’s journey like we have in this past year.  In June I talked about Harry Potter, Star Wars, and The Wizard of Oz . . . but much of the last few months have felt more like the dystopian world of The Hunger Games.  

COVID-19 has brought immense challenges and pain for so many—including our physician community. We have struggled mightily at times. Many of us know a colleague who lost their life to COVID-19.  Many of us have fallen ill, or we have watched a family member or loved one battle the virus. 

We have done things in 2020 that we could not have imagined . . . shining a spotlight in an uncomfortable place—on ourselves—as we repeatedly cried out for more protective equipment to keep us and our patients safe. 

For the financial aid to keep our struggling practices afloat.

For the information and resources to make sense of it all. To provide counsel for our patients. To better understand what we were up against.

As we greet the new year 2021, the pandemic feels a little different now. 

We don’t know if it is the end of the beginning . . . or the beginning of the end. But we are a bit wiser and a bit tougher than before. 

As with every hero’s story, we must learn from the trying times we have experienced. We must grow and move forward because that is what a hero is asked to do. 

We don’t know everything about the journey ahead, but there is plenty we do know. 

This year has shown us the best in physicians and our health care community—the nurses, assistants and staff personnel who are always by our side. 

Who are in the trenches with us even in the most difficult of times . . . and that understand the importance of physician-led teams. 

But this year also has revealed how politics can be corrosive . . . how misinformation and anti-science rhetoric can impede our ability to respond in a health emergency and can magnify the cracks and inequities in our health system.

Nine months into our fight against COVID-19, the pandemic is as dangerous as ever. We have reached record highs and surges continue across the country.

We have learned in this most difficult year that no person and no community is safe from this virus. It reaches everyone . . . no matter their background, their income, or their politics.

And yet, in face of this pandemic—perhaps the greatest threat to public health in our lifetimes—physicians have heroically answered the call.

Time and again, through surges and plateaus, working under intense pressure and at great personal risk, our physician community has risen to the challenge of this moment.

We have done this with courage and with selflessness because of our singular dedication to our patients’ health. 

And now, with a new year ahead and possible vaccines on the horizon . . . we are about to make a fresh start. Change is in the air.

Never again can we allow the politics of division to undermine our ability to deliver the very best care to our patients.

Never again can we allow anti-science bias and rhetoric to undermine our public health institutions . . . and discredit the work of physicians, scientists, and researchers.

Never again can we allow a campaign of misinformation and disinformation to co-opt conversations around public health . . . and sow divisions that only serve to prolong the suffering of so many.

Never again can we allow public health officials to feel the pressure of threats and intimidation simply for doing their jobs.

And especially when lives are at stake, never again should physicians have to fight a war on two fronts—caring for severely ill patients in a raging pandemic . . . while at the same time battling a public relations war that questions the legitimacy of our work and our motives.

This is unacceptable . . . and we will not and cannot continue to work in this atmosphere.

While we have seen the best of physicians in 2020 . . . we were reminded again of the power of the AMA, the TMA, the TCMS, and of the entire Federation community working on our behalf and being our voice when it mattered most. 

Our organizations created tools and resources—all grounded in credible science and evidence—to help us respond to this historic crisis. 

We pushed the administration to accelerate production for testing and PPE. TMA and TCMS kept our practices supplied with life-saving equipment. 

Our medical organizations helped establish a financial lifeline for struggling physician practices, securing tens of billions of dollars in financial support, grants, and interest-free loans to infuse practices with much-needed capital to survive this pandemic. 

Organized medicine was a leading national voice in support of science, evidence, and data as the surest path through this pandemic, launching a major public health campaign to encourage everyone, everywhere to “Mask Up.” 

All of us should be proud of how organized medicine has stood up for physicians this year.

As with every hero’s story, we must learn from the trying times we have experienced. We must grow and move forward because that is what a hero is asked to do. 

That is what physicians are expected to do. 

That is what we expect of ourselves.

All of us are eager to see an end to this pandemic. And with encouraging new reports about vaccines nearing approval, there is tremendous excitement about what the new year will bring.

But we are not there yet. All of us need to continue to do our parts. We need to constantly remind everyone to wear masks, wash hands, and physically distance. We need to remain steadfast and focused until the very end. 

We should not underestimate the fight in our opponent. Every time we feel like we have COVID-19 on the ropes, here and abroad, we see it roaring back.

We have to remain strong and follow where the science leads us.

The next few months will be buzzing with anticipation about the post-COVID world that will emerge. 

Regardless of when that day arrives     . . .  and when normalcy returns, whatever that will look like . . . our AMA, specialty, state, and county societies will play a critical role in shaping the health system of the future.    

A system that ensures that everyone has access to the affordable and meaningful coverage they need. 

A system that relies on science, evidence, and data to guide our approach to public health and prevention. 

A system free of the historic barriers to care . . . and ensures that all patients stand on equal footing.

A system that supports and integrates a revitalized public health infrastructure.

A system that protects the patient-physician relationship from outside influence at all costs.

And a system that prioritizes physician health and wellness . . . and eases administrative burdens that take us away from what we do best . . . caring for our patients. 

Despite the challenges of this past year, and they have been extraordinary, I continue to believe in the power of organized medicine to fix the persistent problems in our health system.

I believe in science and evidence to light our way.

And I believe in the strength and resolve of physicians to take on any challenge . . . and rise to any moment.

The hero’s journey is our journey. And we are exactly where we are meant to be.