Here we go again. CMS has once again proposed cuts in Medicare and Medicaid reimbursement, and the healthcare community is once again rallying to try to stave them off.
CMS last month released its proposed reimbursement changes for 2025, and there were a few victories for radiology.
- CMS finally agreed to pay for CT colonography, and also agreed to unbundle payments for PET radiotracers from the PET scan itself.
But CMS also proposed changes in the Medicare Physician Fee Schedule (MPFS) conversion factor that continue the slow drip of reimbursement reduction for physicians.
- The agency said the proposal would result in no change for radiology, but a deeper dive reveals that’s not the case.
For example, the analysts at revenue cycle management firm Healthcare Administrative Partners have reviewed the MPFS changes, calculating that if Congressional adjustments are factored in, the outlook is quite different…
- Interventional radiology will see a -5.8% reduction in the imaging center global fee and a -1.8% drop in the hospital professional fee, for a combined decline of -4.8%
- The numbers for radiology and nuclear medicine are -3.8% for imaging centers and -1.8% for hospitals, for combined declines of -2.8%
It may seem like -2.8% isn’t a huge cut, but it continues years of steady declines in Medicare reimbursement (HAP notes that the Medicare physician fee schedule has dropped -10% in the last 10 years).
- And as anyone in healthcare knows, the costs that healthcare practices face have only gone up over that period.
There’s always the chance that Congress will come to the rescue, as it did when it passed the Consolidated Appropriations Act of 2024 – indeed, professional medical groups led by the AMA published a letter last week urging lawmakers to reform CMS’ rate-setting system in several ways …
- Enact an annual payment update tied to inflation
- Eliminate the requirement that changes in payments be budget-neutral
- Overhaul the Merit-based Incentive Payment System (MIPS)
- Make modifications to Alternative Payment Models
The Takeaway
The annual ritual in which CMS proposes sharp cuts in Medicare reimbursement only to have Congress lift them at the last minute is a sort of public policy kabuki dance in which the outcome is practically preordained. Medicare reform is badly needed to end this cycle and put physicians on firmer footing so they can focus on what’s important: caring for patients.
