Cardiologists, heart surgeons and imaging experts push for changes that could prevent ‘permanent and unjustifiable Medicare cuts’

Why are budget-neutrality policies so important?

One of the primary reasons the Medicare Physician Fee Schedule (MPFS) often includes reductions in Medicare payments for various therapies and procedures is that Medicare programs are required by law to be budget neutral. If physician reimbursement payments are increased for one treatment, for example, payments must be reduced for another treatment to maintain a neutral budget. If the budget-neutrality threshold is increased to $53 million, it would give Medicare much more room to play with before considering cuts that impact the day-to-day lives of U.S. physicians.

In their letter, the groups pointed to an example of how budget-neutrality requirements impact physicians: a single Medicare decision caused reimbursement payments to drop by more than $5.2 billion from 2013 to 2021.

“The net result in these circumstances is not budget neutrality, but rather permanent and unjustifiable Medicare cuts to physician payments across the board,” the groups wrote.

The 2024 MPFS is final—could policies change by 2025?

The Centers for Medicare & Medicaid Services (CMS) finalized the 2024 MPFS on Thursday, Nov. 2. This final rule included a conversion factor of $32.7375, down 3.39% compared to the 2023 MPFS.

While the ACC’s initial estimate is that reimbursement for cardiology is largely unchanged, this reduced conversion factor is still expected to make a significant impact on providers throughout the country.

Groups are already making their disappointment in the 2024 MPFS known. A new statement from SCAI, for instance, emphasizes the impact these continued cuts are having on patient care. The group also highlighted the importance of new policies going forward.

“We are disappointed that CMS’ final rule for the 2024 PFS continues to slash Medicare reimbursements for physicians, threatening to exacerbate the effect of two decades of payment cuts, undermine physician participation in Medicare, and jeopardize patient access to care. Interventional cardiologists and other physicians must now endure a further decrease in reimbursement despite the rapid rise of practice costs,” SCAI President George D. Dangas, MD, PhD, said in the statement. “SCAI urges Congress to prevent these cuts and to implement a fair and sustainable solution for our broken Medicare physician reimbursement system, including a regular update to payments based on the Medicare Economic Index.”

The Strengthening Medicare for Patients and Providers Act and this latest proposal from Wenstrup, Murphy and Burgess suggest help could be on the way. Will any of these policies gain enough momentum to impact care in 2025? Cardiologists, heart surgeons and cardiac imagers throughout the country certainly hope so.