Becker's Spine Review

31 ASC Physicians brace for 8.42% cut to CMS rates; many consider dropping Medicare patients By Alan Condon P hysician practices are preparing for an 8.42 percent drop in Medicare payment rates next year because of the proposed 4.42 percent reduction in the CMS conversion factor and the 4 percent statutory Pay-As-You-Go sequester, which was implemented to offset congressional spending outside of healthcare. In 2022, medical practices absorbed a 2 percent cut to CMS payment aer the reintroduction of Medicare sequestration and have been combatting rising costs, staff shortages and record inflation, which hit a 21-year high of 9.1 percent this summer. According to a Medical Group Management Association survey, 92 percent of medical group practices reported that the current Medicare rates do not cover the cost of providing care. Among the 517 medical groups surveyed, 58 percent are considering limiting the number of new Medicare patients; 66 percent are considering reducing charity care; 58 percent are considering reducing the number of clinical staff; and 29 percent are considering closing satellite locations. e survey results provide an "alarming look into the projected impact" on the impending 8.42 percent cut to 2023 Medicare rates, Anders Gilberg, senior vice president of government affairs for MGMA, said in a Sept. 21 news release. "With more than 500 medical groups of all sizes and specialties from across the country responding to the questionnaire, this data offers a unique perspective into the real-world consequences such dramatic physician payment cuts would have on physician practices' ability to treat patients." e association has urged Congress to prevent the "looming 2023 Medicare physician payment crisis" by offsetting the proposed 4.42 percent cut to the conversion factor, addressing the 4 percent PAYGO sequester and provide an inflationary update based on the Medicare Economic Index, which afford medical groups the financial stability to ensure seniors have unobstructed access to care, Mr. Gilberg said. n Stark Law changes: Physician compensation arrangements to keep an eye on By Patsy Newit H ospitals and health systems need to update their physician compensation plans after CMS' recent changes to the Stark Law, according to an article in JDSupra from the law firm Foley and Lardner. These arrangements should be "carefully reviewed" if the hospital seeks to meet the Stark Law employment or indirect compensation arrangement exceptions, according to the Sept. 7 report. Three things to note: 1. Physician compensation plans where productivity is above the 75th percentile could trigger review. These plans should ensure that compensation is consistent with the physician's personal productivity, instead of assuming anything below the 75th percentile will be fair market value. 2. Compensation should also be consistent with the services performed by the practitioner. If a physician is compensated based on their advanced practice providers' work relative value units, for example, hospitals should ensure that compensation is explicitly for the services performed by the physician, such as supervision. 3. Indirect compensation agreements should be reviewed, because certain compensation agreements that consider APP work relative value units as physician compensation might not meet commercial reasonableness and fair market value tests. n

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