2023 Proposed Medicare Physician Fee Schedule Reaffirms Need for Congress to Fix Physician Payment Methodology

FOR IMMEDIATE RELEASE 
Friday, July 8, 2022

Statement attributable to:
Sterling Ransone, Jr., MD, president
American Academy of Family Physicians

“The American Academy of Family Physicians (AAFP) is concerned that the Centers for Medicare and Medicaid Services’ (CMS) 2023 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) proposed rule may result in untenable Medicare payment cuts for family physicians in 2023 and jeopardize patients’ timely access to essential primary care. Federal Medicare physician payment laws prevent our nation from making vital investments in primary care. The AAFP calls on CMS and Congress to address these limitations amid rising practice costs and an ongoing public health crisis.

“Family physicians provide high-quality, comprehensive care to our patients, but our current payment system is stymieing equitable access to primary care. The U.S. under-invests in primary care, and we urge CMS to build on the proposals in this rule to invest in primary care more effectively.

“Wide-ranging reform is needed to protect Medicare beneficiaries’ access to comprehensive primary care in their own communities and advance health equity. CMS cannot accomplish this alone. To support physician practices, stem costs for patients and prevent consolidation, the AAFP continues to call on Congress to avert Medicare Part B payment cuts set to go into effect in 2023 and enact positive, annual updates for Medicare physician payments. Medicare beneficiaries deserve a system that gives physicians the tools and flexibility they need to address their patients’ unique health needs, including behavioral health and unmet social needs. Only then can we truly move the needle on population health outcomes and health care expenditures.

“Additionally, our physicians need a Medicare payment system that enables them to invest in practice transformation and infrastructure to adopt alternative payment models (APMs). Physicians in APMs are better equipped to provide enhanced services that are not supported by fee-for-service payment rates. However, outdated Medicare payment rates, inadequate support and burdensome timelines are undermining the move to value-based care and, in turn, exacerbating our nation’s underinvestment in primary care.

“CMS proposes several changes to the Medicare Shared Savings ACO Program, which would enable practices to invest in infrastructure improvements when transitioning into an ACO, as well as comprehensively meet patients’ needs without facing unfair penalties. While these modifications may help more family physicians in rural and underserved communities succeed in MSSP, more must be done to help physicians who are not a part of ACOs move into APMs.

“Unfortunately, the QPP has failed to adequately support clinicians in the move to APMs, further emphasizing the need for comprehensive Medicare physician payment reform. When Congress passed the Medicare Access and CHIP Reauthorization Act, they created a bonus payment for participants in advanced APMs, the goal being to incentivize more clinicians to move out of fee-for-service to APMs. However, this bonus is set to expire at the end of the year, which will further slow physicians’ transition to value-based care. The AAFP supports legislation to extend the advanced APM bonus for another five years and to reform the qualifying criteria so that more clinicians can be successful.

“We strongly urge Congress to invest in sustainable updates to payments made under the Medicare physician fee schedule to account for inflation in practice costs and address the limitations of Medicare budget neutrality requirements.

“The AAFP is pleased that CMS has proposed several changes to supervision and billing rules for certain behavioral health clinicians that will enable them to help manage patients' behavioral health needs as part of the primary care team. We have continually advocated for greater financial support to stand up and sustain integrated behavioral health models.

“We look forward to continuing to work with CMS and Congress to build a better payment system for all clinicians. Now more than ever, we must address the diverse health needs of patients and their communities in order to improve health outcomes.”

Editor's Note: To arrange an interview with Dr. Ransone, contact Julie Hirschhorn at jhirschhorn@aafp.org. 

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