Medicare Payment Cuts: A Threat to Patient Care

Substantial changes to Medicare payments for physicians are here in 2023, and interventional cardiologists, particularly those who operate office-based practices, should take note. Late in 2022, the Centers for Medicare & Medicaid Services (CMS) finalized a change to the 2023 physician fee schedule (PFS), which reduced the conversion factor that is used along with relative value units to calculate payments from Medicare to physicians. This means a decrease in reimbursement payments for physicians.

These reductions are because of budget neutrality requirements for the CMS, which can only be changed through an act of Congress. For 2023, Congress both failed to fully prevent the proposed reductions from the CMS and allowed for the further phase-in of the calculation of clinical labor pricing, which will substantially affect the financial viability of office-based practices. This undermines the economic viability of clinical practices and makes critical care more difficult to access, particularly for Black, Latino, and rural Medicare patients. As an organization, the Society for Cardiovascular Angiography & Interventions (SCAI) must ensure federal policy aligns with the economic realities of our field and that Congress reforms PFS to make it sustainable in future years.

CMS issued a final rule¹ on November 1, 2022, which reduced CY 2023 payments by 4.5% through a decrease in the conversion factor from $34.61 in 2022 to $33.06 in 2023 and the expiration of a temporary 3% statutory payment increase. The SCAI Government Relations Committee and other medical societies have staunchly opposed these cuts. Through the omnibus spending legislation passed at the end of 2022, Congress prevented 2.5% of the conversion factor cut in 2023 and 1.25% of the cut in 2024. In addition, changes to clinical labor pricing will reduce reimbursement for many physicians, including interventional cardiologists. These cuts continue a trend of cumulative payment reductions and a lack of inflationary adjustments over the past decade, reducing the PFS by 20% to 40% for office-based specialists.

Although it may seem reasonable to update the clinical labor data, a faulty formula results in significant reimbursement cuts for our practices. This is why the SCAI Government Relations Committee, along with other medical societies, worked with Representatives Bobby Rush (D-IL) and Gus Bilirakis (R-FL) on a letter² to urge the CMS to not finalize the clinical labor policy in the PFS Final Rule. Unfortunately, budget neutrality constraints enacted by the Congress led to these changes.

A confluence of federal policy, high inflation, and COVID-19 exacerbated the challenge to the economic viability of our practices. In addition to the negative effect on interventional cardiologists who are employed in hospitals or corporate-owned practices, even greater adverse economic pressures impede the ability of independently employed interventional cardiologists to viably operate. This reality drives a continued migration to health system employment, likely reducing competition and access in our health care environment.

Unfortunately, economic instability affects our patients who are dependent on Medicare and will likely have a profound negative effect on health equity, with a disproportionate effect on our Latino and Black patients. The recommended reimbursement changes decrease reimbursement for dialysis vascular access by 18% and for peripheral arterial revascularization procedures by 22%. For our Black patients who already face increased rates of peripheral arterial disease and amputations, these reductions pose a threat and will result in decreased access to clinic-based revascularization sites. In addition, potential clinic and hospital closures will likely limit geographic access to sites of care, further increasing a substantial divide between rural and metropolitan health care access.

The SCAI Government Relations Committee is engaged on multiple fronts to change the approach to PFS—both to ameliorate cuts that have taken place over previous years and to reform PFS to ensure equitable payment practices that reflect the economic realities interventional cardiologists face. We have worked with a broad coalition including the CardioVascular Coalition, the Society for Vascular Surgery, and the United Specialist for Patient Access on the Medicare Coalition Payment Stability Letter,³ in addition to the aforementioned Rush-Bilirakis letter campaign, which highlights the negative effect of PFS “budget neutrality” requirements and emphasizes the need for fundamental PFS reform.

We must brace ourselves for the acceleration of economic instability that will challenge the viability of practices and adversely affect patient access, disproportionately affecting Black, Latino, and rural Medicare patients. The SCAI Government Relations Committee will work with federal legislators to drive a more sustainable and equitable PFS. Congressional failure to address this issue will result in fewer interventional cardiologists and avoidable harm to our patients.

Take action now! Contact your senators and member of Congress, with the following link, and let them know that this is not acceptable: https://scai.quorum.us/campaign/45550/.