July 13, 2022

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued its Medicare Physician Fee Schedule (PFS) proposed rule (PR) for calendar year 2023.  Though the PR primarily addresses Medicare Part B conditions and claims, there may be some provisions found therein that will have direct or indirect effect on hospitals and their decision-makers.  Indeed, the American Hospital Association (AHA) devoted an entire article to the PFS PR, indicating its potential impact on hospitals and health systems.  The following is a summary of some of the government’s Part B proposals as outlined in the aforementioned AHA article, as well as a fact sheet released by CMS relating to the PR. 

Conversion Factors

The PR cuts the PFS conversion factor (CF) to $33.08 in 2023, as compared to $34.61 in 2022, which reflects the following:

• The expiration of the three-percent statutory payment increase;
• A zero-percent CF update; and
• A budget-neutrality adjustment.

The anesthesia CF for 2023 is set in the proposed rule at $20.71.  This is a drop from the current year’s anesthesia CF of $21.56, reflecting a four percent decrease in reimbursement for anesthesia services in the upcoming year.

Shared Savings Program

The PR contains several proposed changes to the Medicare Shared Savings Program (MSSP).  For example, it would modify the mechanism by which benchmarks for accountable care organizations (ACOs) are calculated, reportedly to “help sustain long-term participation and reduce costs.”  It also would provide increased flexibility for certain smaller ACOs to share in savings. 

The PR also proposes updates to MSSP quality-measurement policies.  These would include a new health equity adjustment that would award bonus points to ACOs that serve higher proportions of underserved or dually-eligible beneficiaries.

Quality Payment Program

The PR proposes five new, optional Merit-based Incentive Payment System Value Pathways (MVPs) that would be available beginning in 2023.  According to the AHA, “These MVPs align the reporting requirements of the four MIPS performance categories around specific clinical specialties, medical conditions or episodes of care.” 

The PR also contains the following proposed changes:

• Refinements to the MIPS subgroup reporting process;
• An increase to the quality data completeness threshold; and
• Changes to the requirements and scoring of the Promoting Interoperability category.

There are also requests within the PR for input on policy ideas for advancing health equity and transitioning to digital quality measurement.  Comments are due September 7.

Telehealth Services

For 2023, CMS is proposing a number of policies related to Medicare telehealth services including making several services that are temporarily available as telehealth services for the PHE available through 2023 on a Category III basis.  The agency is also proposing to extend the duration of time that services are temporarily included on the telehealth services list during the PHE, but are not included on a Category I, II, or III basis for a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022).

Finally, the PR details that the proposed policies are intended to extend certain flexibilities in place during the PHE for 151 days after the PHE ends, including allowing payment for RHCs and FQHCs for furnishing telehealth services (other than mental health visits that can be furnished virtually on a permanent basis) under the payment methodology established for the PHE.  This will allow such services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be furnished via audio-only telecommunications systems. 

We will have additional details arising from the PR in our next alert.  For now, if you have questions, please go to info@miramedgs.com.