The recent decision by the Centers for Medicare and Medicaid Services (CMS) to implement a 2.8% payment cut for physicians as part of the 2025 Medicare Physician Fee Schedule has been met with strong opposition from medical groups.

Concerns about Physician Practices and Patient Access to Care

The American Medical Association (AMA) and the American Academy of Family Physicians have both expressed concerns about the sustainability of physician practices and patient access to care, as Medicare payments are set to decrease while the costs of delivering care are projected to rise.

Ongoing Challenge of Inadequate Medicare Payment Rates

This issue of inadequate Medicare payment rates has been an ongoing challenge for healthcare providers, and it requires congressional intervention each year to avoid payment cuts.

Bipartisan Bill to Halt Payment Reductions

In response to the finalized payment cuts, a bipartisan bill has been introduced in the House to halt the reductions. The Medicare Patient Access and Practice Stabilization Act proposes a 4.7% payment update for 2025, effectively eliminating the scheduled 2.8% cut. The AMA has urged Congress to act quickly to prevent the cuts from being implemented.

Impact on Telehealth Services

The finalized 2025 Physician Fee Schedule conversion factor will decrease to $32.35, reflecting a 0% update mandated by law for 2025 and the expiration of a temporary payment increase. This reduction further widens the gap between practice expenses and reimbursement rates. The final rule also addresses telehealth services, which may face limitations unless Congress intervenes. While certain telehealth flexibilities have been extended, Medicare beneficiaries may face restrictions for most telehealth services starting January 1, 2025. This could have a significant impact on access to care, particularly for those in rural areas.

New MIPS Value Pathways and General Supervision for Physical Therapy Assistants

The rule also introduces new MIPS Value Pathways under the Quality Payment Program, targeting various specialties and aiming to streamline reporting and improve care quality. The expansion of general supervision for physical therapy assistants has been praised for alleviating administrative burdens and enhancing service delivery.

Monitoring Developments and Advocating for Sustainable Solutions

These changes in Medicare payment structures and telehealth regulations reflect broader trends in healthcare delivery and reimbursement, and stakeholders in the medical community are closely monitoring developments and advocating for sustainable solutions.