TMA Fights Another Proposed Medicare Pay Cut, While Pressing for Reform
By Emma Freer

The recently proposed 2023 Medicare physician fee schedule would deepen physician pay cuts while expanding access to telemedicine and behavioral health care, among other changes.   

If implemented, the proposal also would significantly modify two value-based care initiatives – the Quality Payment Program’s Merit-Based Incentive Payment System (MIPS) and the Medicare Shared Savings Program (MSSP) – in an effort to transition more Medicare patients from fee-for-service arrangements.    

Texas Medical Association President Gary Floyd, MD, says this logic is flawed, as physician pay cuts threaten practice viability and, with it, patients’ access to care, regardless of any expansion plans or attempts to catalyze value-based care.    

In a Sept. 6 comment letter, TMA responded to the Centers for Medicare & Medicaid Services’ (CMS’) 984-page proposal, raising concerns about the pay cut and other proposals related to scope expansion, e-prescribing penalties, and physicians’ administrative burden.  

The final 2023 Medicare physician fee schedule is expected in early November, and most provisions will take effect Jan. 1. In the meantime, TMA has joined the American Medical Association and other state medical and national specialty societies in calling for wholesale reform.  

“In addition to immediately addressing the forecasted cuts in 2023, TMA calls on Congress and policymakers to provide stable and predictable Medicare physician payments,” Dr. Floyd wrote in TMA’s 21-page comment letter. “Physicians and the patients in their care deserve a reliable Medicare physician payment system that keeps up with inflation and practice costs.”   

TMA’s comment letter focused on the following CMS proposals:   

• Cutting Medicare physician pay by 4.4%;  
• Further adjusting MIPS;  
• Rejiggering MSSP to spur participation;  
• Extending pandemic-era telehealth flexibilities;  
• Allowing nonphysician health care professionals to provide behavioral health care under general, rather than direct, physician supervision; and  
• Implementing financial penalties for physicians who don’t e-prescribe controlled substances.  

If enacted, the proposed 4.4% cut would be one of many to take effect in 2023 – barring congressional intervention – including a sequester cut and other reductions mandated by law.    

In its letter, TMA calls on Medicare to work with the AMA RVS Update Committee (RUC) to appropriately value all services and implement payment policies that are fair for all physician specialties. That includes eliminating budget neutrality requirements that “creat[e] a system of ‘winners’ and ‘losers,’” because any pay increases and decreases must offset one another.  

As for Medicare’s value-based care programs, TMA again pleaded with the agency to “tweak MIPS requirements only as needed or when doing so significantly reduces the burdens physicians bear while navigating the MIPS program. … CMS should maintain consistency in MIPS requirements if the agency earnestly hopes to encourage physician participation in this overly complicated program.”   

On the other hand, TMA welcomed some of the MSSP changes that could reduce barriers to participation, such as advance incentive payments, while urging CMS to make such options even more accessible.   

Among CMS’ other proposals, TMA asked that CMS:   

• Permanently continue telehealth flexibilities and pay for telehealth services at parity with in-person service rates after the COVID-19 public health emergency and the 151-day extension concludes; 
• Not unfairly favor health visits with telemedicine-only companies with imbalanced pricing incentives; 
• Defer to state laws and rules that govern a health professional’s scope of practice/licensure, including any delegation and supervision requirements applicable under state laws; and 
• Postpone e-prescribing of controlled substances enforcement for the next two years but not impose penalties for noncompliance.   

TMA continues to monitor development of the 2023 Medicare physician fee schedule. Once CMS has released its final fee schedule, TMA will help prepare Texas physicians for the impending changes.