TMA Critiques CMS’ Proposed Fee Schedule for Myriad Shortfalls
By Phil West

Noting that “private practices are breaking under the pressure of lack of adequate payment and increasing overhead,” the Texas Medical Association recommended numerous improvements to the 2025 proposed Medicare physician fee schedule. 

The schedule leads off with a 2.8% cut to physician payments and adds layers of complexity to its Quality Payment Program, among other administrative burdens.

As of this writing, the Centers for Medicare & Medicaid Services (CMS) was still considering public comments, with the final 2025 fee schedule expected to be released in November. 

Amid some bright spots, TMA’s lengthy comments to CMS detail the annual rigamarole of an impending pay cut, a maze of changes to the Merit-Based Incentive Payment System (MIPS), and the absence of permanent telehealth solutions, among other shortfalls, highlighting the urgent need for relief if physician practices are to remain viable.   

“Physicians’ primary mission is to help, treat, and heal their patients who are sick and suffering, not to check boxes and chase down paperwork,” TMA President G. Ray Callas, MD, wrote. “TMA urges CMS to continuously evaluate methods and policy levers that can reduce physician burnout, which leads to the unintended consequence of shortages of physicians and patient access to care.” 

TMA welcomed several positive payment-related changes in the latest fee schedule including:  

• Fixes to the evaluation and management add-on complexity code; 

• Three new codes recognizing “advanced primary care management;” 

• The addition of three new covered telehealth services; 

• Several new codes related to behavioral health services; and 

• Expanded coverage of hepatitis B vaccination, PrEP for HIV infection prevention, and colorectal cancer screenings. 

Conversely, TMA’s letter made clear how far CMS still needs to go to address what it described as the agency’s “failure to address the Quality Payment Program’s complexities, inconsistencies, and administrative burdens,” calling it “a devastatingly missed opportunity for the Medicare program, Medicare beneficiaries, and the physicians who care for them.”   

On top of Medicare’s proposed 2.8% overall pay cut, MIPS penalties threaten to cut physician payments by up to another 9% for not meeting program requirements “with no evidence that the program supports care improvements,” TMA wrote. 

Adding insult to injury, CMS has signaled that traditional MIPS reporting will be replaced by full adoption of its newer MIPS Value Pathways (MVP) program as early as 2029. MVP reporting is currently voluntary, and “while TMA acknowledges steps that CMS has taken to try to ease clinicians into the transition from MIPS to MVPs, TMA skeptically views the program as the same old MIPS, just rebranded and wrapped in a shiny new package,” the letter states.  

Rather than force physicians into MVPs, TMA urges CMS to work with the American Medical Association’s MIPS workgroup, of which TMA is a member, and to “focus on moving physicians to risk-based systems in voluntary, physician-led alternative payment models.” 

At the same time, TMA welcomed CMS proposals that could ease burden on low-revenue accountable care organizations with “prepaid shared savings” or advanced payments that can be invested on the front end.  

However, for physicians investing in telemedicine technology and providing such services to expand access to care, TMA advocated in its letter they receive appropriate payment with inflationary updates, as telehealth facilities already do.  

TMA also continues to press for the permanent removal of existing geographic site restrictions so patients can continue to receive care in their own home. A pandemic-era waiver allowing such flexibility expires on Dec. 31. 

As Congress finishes its final few months of the current session (which convened on Jan. 3, 2023, and is set to end Jan. 3, 2025), TMA is imploring Congress to act on four key reforms to the Medicare Access and CHIP Reauthorization Act, with legislators addressing three of those via bills before Congress now. Those include:  

• An annual, permanent inflationary payment update in Medicare that is tied to the Medicare Economic Index; 

• Updates that allow for more accurate estimates of physician payment versus being tied to “budget neutrality” constraints that require any payment increases or decreases to be offset; 

• An overhaul of MIPS that removes undue administrative and uneven financial burdens; and 

• Improvements to alternative payment model options that boost physician participation in those programs. 

TMA has created materials for your office that allow patients to send prewritten emails to their U.S. senator and representatives. Get the tools on TMA’s Medicare advocacy webpage.