Radiology groups call on Congress to make 4 fixes to final physician fee schedule
Radiology societies are calling on Congress to make four fixes to the final Medicare Physician Fee Schedule before the year’s end.
Imaging groups led by the American Medical Association made their plea to House and Senate leaders in a letter sent Thursday. They note that Medicare physician payments have fallen 33% since 2001 when adjusting for inflation in practice costs.
Those signing the message included the American College of Radiology, Society of Interventional Radiology and American Society for Radiation Oncology. They contend that—as payment falls further behind the cost of providing care—it’s becoming increasingly difficult for physicians to continue caring for Medicare beneficiaries.
“Medicare patients need access to physicians, and physicians need a payment system that works. Congress has an opportunity to protect access to care and give physician practices the stability they need to keep serving Medicare patients,” AMA President Willie Underwood III, MD, MSc, MPH, said in a statement Nov. 12. “These four reforms are practical, bipartisan steps Congress can take now to strengthen Medicare and protect patients.”
The letter comes in response to the final fee schedule, released on Nov. 4. Medicare on Jan. 1 plans to implement a 2.31% cut to the conversion factor used to calculate radiologist payments, among other changes. AMA contends these changes will “jeopardize” patient access to care and weaken practice stability, particularly for small, rural and independent groups.
To avoid this, ACR, SIR, ASTRO and others are suggesting the following:
1. Extend the 2.5% payment update: Previously passed as part of the Working Families Tax Cut Act, the measure is slated to expire when the calendar flips. Physicians want to see this temporary pay bump prolonged at least through 2027, helping to “narrow the widening gap between payment updates and rising practice costs.” This move is endorsed by the Medicare Payment Advisory Commission and would help counteract a projected 2.5% increase in practice costs, due to inflation.
2. Enact the Provider Reimbursement Stability Act: The measure is backed by both political parties and was previously approved 44-0 by the House Ways and Means Committee. It would require the Centers for Medicare & Medicaid Services to prospectively correct budget neutrality adjustments when actual service use differs substantially from original estimates. The Congressional Budget Office has identified two CMS overestimates since 2015, which together lowered doc pay rates by about 1.8 percentage points.
“Physicians and patients should not face permanent cuts to offset spending that never occurred,” the groups charged.
3. Delay the modifier-25 payment reduction: CMS is moving forward with plans to cut payments when office visits are billed the same day as a procedure. The agency is targeting instances where physicians use this “modifier 25” to bill for different services in the same visit, paying 20% less for the second service and beyond. However, radiology groups contend that existing valuation processes already address overlapping work, and CMS has not provided justification that this change is warranted.
“The cut would particularly threaten independent office-based practices and could result in payments that are less than the direct cost of some services,” they wrote.
4. Cap MIPS penalties at 2% and require timely performance data: Radiologists and other physicians often receive feedback in the Merit-based Incentive Payment System long after the performance year. This can leave little opportunity to improve care, with almost 40% of solo clinicians penalized this year based on their 2024 MIPS scores.
“Quality improvement should be driven by useful data provided during the performance year, not penalties of up to 9%,” the groups wrote to Speaker Mike Johnson, House Democratic Leader Hakeem Jeffries, Senate Majority Leader John Thune, and Senate Democratic Leader Charles Schumer.
“Together, these steps would provide near-term stability while advancing broader reform of the Medicare Access and CHIP Reauthorization Act of 2015, including predictable, inflation-based updates to ensure Medicare delivers on its guarantee to provide patients with access to the local physicians who treat them,” they added.
Others signing the message included the American Society of Nuclear Cardiology, the Medical Group Management Association, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography and numerous others.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.