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Medicare PHYSICIAN payment: Positive Payment Updates

Our Position 

ASCRS urges Congress to extend positive physician payment updates to the conversion factor to ensure that Medicare fee-for-service (FFS) and the programs under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) continue to be viable options for ophthalmologists.

Issue Brief

How it Impacts You

In 2015, Congress enacted legislation to repeal the Sustainable Growth Rate (SGR) formula used to update Medicare physician fee schedule payments and establish new payment mechanisms to incentivize Medicare physicians in the direction of value-based care and delivery models – the Merit-based Incentive Payment System (MIPS) and A-APMs. To provide a smooth transition, MACRA included five years of much-needed 0.5% positive payment updates for all physicians. However, as of January 1, 2020, the law freezes Medicare physicians' payment rates for six years, until 2026. And, given CMS’ budget neutrality requirements, Medicare payments to physicians will decrease during this time as a result of CMS’s policy in the 2020 Medicare Physician Fee Schedule final rule that increase the value of standalone E/M codes in 2021, but not the value of post-operative E/M visits included in 10- and 90-day global surgical codes. In addition, CMS created a new E/M add-on code for patients with chronic or complex disease. The increase to the standalone E/M codes and the advent of the add-on code is expected to have a significant redistributive effect, transferring value from procedure-based specialties to primary care by decreasing the conversion factor. Additionally, according to a recent Medicare Trustee’s report, physicians will struggle to provide care at the current payment level since inflation is expected to increase physician costs by 2.2% while, at the same time, being required to ramp up participation in the Quality Payment Program (QPP).

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