Jeremy Selley, DO, FACOEP

Why are we still talking about congress and physician reimbursement?  If you remember back in 2015 congress finally passed a “fix” called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that fixed the Sustainable Growth Rate (SGR) that required 17 yearly fixes from 1998 to 2015 when the MACRA was passed.  This MACRA is what Center for Medicaid Services (CMS) uses to calculate the Physician Fee Schedule (PFS).  MACRA was supposed to streamline multiple quality programs under the new Merit Based Incentive Payment System (MIPS) and give bonus payments for participation in eligible alternative payment models (APMs).  In 2020 the No Surprises Act (NSA) was signed into law that allows for physician/groups to charge for their cost sharing amount.  This is calculated based on the median in-network amount for similar plans and services in that geographic area called the qualified payment amount (QPA). This has been the most recent legal battle you might have heard about where plans have been refusing to pay ER bills altogether or not considering all the factors in the payment because of flawed interpretation.

H.R. 2474 Raul Ruiz, M.D. (D-CA 25th) introduced (4/3/23) this bill modifies the PFS to be based off a single conversion factor and provides an update that is equal to the annual percentage increase in the MEI beginning in 2024.

The Medicare Economic Index (MEI) measures the average annual price change for inputs of physician services or practice cost of inflation.

This bill hasn’t moved yet, so ACEP was encouraging you to contact your representatives to sign onto a bipartisan letter to house leadership led by Drs. Ami Bera, M.D. (D-CA 6th) and Larry Bucshon, M.D. (R-IN 8th) urging leadership to make Medicare payment system reform a priority this year.

Please sign up for ACEP 911 Grassroots Network updates if you do not already as it updates you with issues like this and will send you an email with a link that takes 30 seconds to fill out a few times per year.  If you do not have the time to attend D.O. on the Hill or ACEP LAC, or similar, please at the very least send your representatives emails urging their support when required.  Jeffrey Davis also does a weekly regulatory blog through McDermott Consulting that you can sign up for as well.