The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized a nearly 2.9% cut for 2025 in physician payment rates used to reimburse palliative care care practitioners, among other professionals.
The final rule also states that the telehealth flexibilities implemented during the COVID-19 public health emergency will expire at the end of this year unless Congress intervenes. Physicians and other professionals will have to follow pre-COVID restrictions on telehealth, with few exceptions.
Industry organizations were quick to denounce the pay cut.
“To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” American Medical Association President Dr. Bruce Scott said in a statement. “For physician practices operating on small margins already, this means it is harder to acquire new equipment, harder to retain staff, harder to take on new Medicare patients and harder to keep the doors open, particularly in rural and underserved areas.”
Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. This includes practitioners in a variety of settings, including physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories and beneficiaries’ homes.
Fee-for-service Medicare continues to pay for the bulk of palliative care delivered to seniors in the United States, using the rates established in the physician fee schedule final rule.
The final rule also includes a new coding and payment for caregiver training, which can be done via telehealth or in person. This would allow physicians to reimburse for caregiver training services in things like preventing pressure ulcers, wound care and infection control, among other topics.
It also permanently adds several items to Medicare’s Telehealth Services List, which governs the types of care that can be delivered virtually. These include caregiver training services, PrEP counseling for HIV prevention and safety planning interventions.
CMS will also allow audio-only communications for physician telehealth visits if a patient is not capable of or does not consent to using video technology.
Another provision would allow Accountable Care Organization’s participating in the Medicare Shared Savings Program (MSSP) to receive advance payments on their anticipated shared savings if they have shown if they have a “history of success” in the program.
A group of bipartisan lawmakers has introduced a bill to establish a pay increase and negate the CMS cuts, led by Rep. Greg Murphy (R-North Carolina), who is a physician. The Medicare Patient Access and Practice Stabilization Act would increase physician fee schedule patients by 4.7% for 2025.
“America’s physicians are at a breaking point and access to high-quality, affordable care is at risk for millions of Medicare patients,” Murphy said in a statement. “When a physician sees a Medicare patient, they do so out of the goodness of their heart, not because it makes financial sense … This bipartisan legislation would stop yet another year of reimbursement cuts, give them a slight inflationary adjustment, and protect Medicare for physicians and patients alike.”
