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Sep 20, 2023

Contact: Grant Herring

USPA Files Comment Letter on Proposed MPFS Cuts

Washington, DC — Earlier this week, the United Specialists for Patient Access (USPA) submitted a comment letter to Chiquita Brooks-LaSure, the Administrator of the Centers for Medicare and Medicaid Services. USPA restated its strong objections to the proposed cuts included in the 2024 Medicare Physician Fee Schedule (MPFS) released in July by the Centers for Medicare & Medicaid Services (CMS).


USPA CY 2024 PFS Proposed Rule Comment (CMS-1784-P) (1)
Download PDF • 1.37MB

USPA is categorizing the latest round of cuts as a perfect storm. The organization is calling on Congress to pass the Providing Relief and Stability for Medicare Patients Act of 2023 (H.R. 3674) to remedy the actions of CMS.

The letter states, in part, “While ‘budget-neutrality’ sounds like good policy, when it operates within a Physician Fee Schedule that has not kept up with inflation, it results in massive swings in reimbursement and punishes providers irrespective of the value they add to the healthcare system. As a result of budget-neutralizing an underfunded system, the 2021 Physician Fee Schedule (PFS) Rule cut the conversion factor by 10% after an update to E/M data, which had a disproportionate impact on non-primary care providers…Due to ongoing cuts under the Physician Fee Schedule, office-based providers are left with a limited set of options: (1) close their office, (2) join a hospital or (3) convert to an ASC.

The letter goes on to say, “The proposed cuts in the 2024 PFS Proposed Rule will have profoundly negative effects on health equity. While the Administration has launched a number of initiatives aimed at addressing health inequity through the elimination of disparities in health care, the 2024 PFS Proposed Rule actually threatens to undermine these initiatives in areas throughout the PFS by continuing to phase in the 2022 PFS clinical labor cuts.”

The letter makes the following request: “In the 2024 PFS Proposed Rule, CMS states continued interest in promoting “stability and predictability” in the PFS. We believe it would be best for CMS to truly “prioritize stability and predictability over ongoing updates” by temporarily freezing the implementation of further policy updates – including the clinical labor policy in 2024 through 2025 and the implementation of G2211 in 2024 – that will result in further significant redistributions to the Physician Fee Schedule. Instead, we urge CMS to focus on fundamental PFS reform.”

Dr. Mark Garcia, USPA board member and CMO for American Vascular Associates, said, “This proposed rule change and the ongoing cuts to office-based providers are causing a perfect storm that will wipe out specialists and patient access to quality care. As constituted, the new rule will contribute to undermining patient access and widening the health equity gap because office-based providers will be forced out of business. Specialists cannot continue to see dramatic cuts year after year, manage record inflation, treat COVID-19, and at the same time continue to provide quality care to patients.”

Garcia continued, “From 2006 onwards, we have witnessed a persistent decline in funding for office-based specialists, with an average reduction of approximately 30% in the Physician Fee Schedule. The detrimental effects have been exacerbated by the pandemic and soaring inflation rates. Record numbers of office-based centers have already shuttered, and if further cuts to the PFS continue, this trend will escalate rapidly. As a consequence, patients will be compelled to seek care in hospitals, resulting in higher costs and increased burdens. It is imperative that Congress H.R. 3674 to stop mitigate these looming cuts to office-based specialists."


The Cause of the Perfect Storm:

  • Ongoing clinical labor cuts to office-based specialists.

  • CMS-initiated cuts are layered on top of inflationary pressures; the MPFS pie hasn’t increased to keep pace with inflation.

  • Disparities in payment between hospitals and office-based providers.

  • MPFS rebalancing policies of reimbursement away from specialty care.

  • Specialty providers are squeezed so hard that they can’t stay in business and are forced to be acquired; causing health system consolidation and more expensive care.

  • Damage caused by MIPS to independent practices (According to a study in JAMA, MIPS eligible clinicians affiliated with better resourced health systems were associated with significantly better 2019 MIPS performance scores).

The Impact of the Perfect Storm:

  • Undermining patients’ access to care, particularly in rural and underserved areas.

  • Widening the health equity gap.

  • Higher costs as patients are forced to the hospital setting for care, which can be far more costly and burdensome than the office-based lab.

The Solution:

  • USPA has endorsed the Providing Relief and Stability for Medicare Patients Act of 2023 (H.R. 3674), introduced by Rep. Gus Bilirakis (R-FL-12), Rep. Tony Cardenas (D-CA-29), Rep. Greg Murphy, MD (R-NC-3), and Rep. Danny Davis (IL-D-7).

  • Physician payments under the MPFS = RVUs (relative value units) * conversion factor. H.R. 3674 addresses ongoing RVU cuts due to the clinical labor policy and other policies which have been the main source of office-based specialty cuts in recent years.

  • Together with the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which addresses ongoing conversion factor cuts, H.R. 3674 will prevent major disruptions to care while addressing concerns about the future of Medicare physician payments.


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