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Jun 4, 2024

Contact: Grant Herring

OBFA Highlights Disturbing Medicare Data For 195 Office-Based Interventions in the Medicare Physician Fee Schedule

Washington, DC — Today, the Office-Based Facility Association (OBFA) shared its concerns on Centers for Medicare & Medicaid Services (CMS) data that paints a bleak picture for patients and independent practices across the country.

According to 2024 CMS data, there are 195 services under the Medicare Physician Fee Schedule (MPFS) for which Medicare reimbursement does not even match direct costs let alone reimburse the physician for their work. Every one of these services are office-based interventional services and this is a key catalyst for independent practice closure and consolidation. This under-reimbursement has been a key driver in a trend which, since 2006, has resulted in MPFS cuts to cardiology, radiation oncology, vascular surgery, and interventional radiology of -18%, -21%, -28%, and -35%, respectively. A 2023 multi-specialty survey of non-hospital providers found that 53% of respondents “believe the likelihood of the practice’s success is unlikely.”

These data underscore the dire need for a new site-of-service for office-based interventional services under Medicare and the AMA RUC has long recommended “that CMS separately identify and pay for high cost disposable supplies priced more than $500.” Under a new policy currently under consideration in Congress, services in the new “Office-Based Facility” site-of-service would include high-cost supply services over $500, which are no longer adequately reimbursed by the MPFS.

Outpatient Endovascular and Interventional Society (OEIS) Past President and OBFA board member Jerry Niedzwiecki, MD, said, “It’s astonishing that Medicare’s own data shows that Medicare reimbursement no longer covers even the direct practice costs, not to mention physician work, for at least 195 office-based interventional services in the MPFS. This cannot continue and underscores the reason why we need fundamental reform of the MPFS to ensure patient access to community-based, interventional care.”

OBFA firmly believes these data underscore the need to pay separately from the MPFS for high-cost supply services and establish a new “Office-Based Facility” site-of-service to stop further closures of independent, interventional practices and provide additional resources for overall PFS reform.

Dr. Niedzwiecki added, “We know that establishing a new Office-Based Facility site-of-service will stop further closures of independent office-based specialty centers and help with the overall effort of PFS reform.”

Medicare Physician Fee Schedule Reimbursement is Less Than Costs for At Least 195 Office-Based Physician Fee Schedule Services

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