Becker's ASC Review

44 HEALTHCARE NEWS 44 5 ways Medicare's proposed cuts will affect physicians in 2023 By Alan Condon P hysicians are bracing for an 8.42 percent drop in CMS payment rates in 2023 and many medical groups are considering limiting the number of new Medicare patients or reducing charity care as a result, according to the Medical Group Management Association. e proposed cuts are projected to significantly disrupt access to care, practice operations and investment throughout the healthcare industry. If implemented, here are the top five practice trends that will occur, according to MGMA: 1. Reducing or eliminating the number of Medicare beneficiaries served. 2. Projected delays in scheduling care, resulting in up to six months' wait for visits. 3. Decreased ability to recruit staff at all levels, including physicians, clinical support staff and administrative staff, especially in rural areas. 4. Reduced participation in value-based contracts as limited resources and revenue divert away from nonessential practice activities. 5. Closing satellite offices or selling the practice due to insufficient revenue streams. e projected Medicare cuts will also affect Medicaid and private payer rates, which are oen contracted as a percent of Medicare rates, according to the MGMA. As Medicare reimbursement declines, practices will likely see a decrease in operating revenues, which will further reduce their ability to provide timely, high-quality care to patients. n 3 changes affecting physician group reimbursements By Patsy Newitt S ince 2015 there have been three major changes to physician group reimbursements, according to VMG Health's "Annual Healthcare M&A Report 2022." The organization laid out the three biggest changes: 1. The Senate passed the Medicare Access and CHIP Reauthorization Act in April 2015, which removed the sustainable growth rate formula from the Medicare physician fee schedule conversion factor. The formula was then replaced with a fixed .5 percent annual increase through 2019. From 2019 to 2025, individual physicians can still achieve payment increases through participation in the merit- based incentive program. 2. The annual increase was then reduced to 0.25 percent by the Balanced Budget Act of 2019. 3. In November 2021, CMS released the Medicare physician fee schedule final rule payment for 2022 with a conversion factor of $33.59, a decrease of $1.30 from the 2021 conversion factor of $34.89. n Biogen pays $900M to settle physician kickback allegations By Patsy Newitt P harmaceutical company Biogen has agreed to pay $900 million to resolve allegations it paid kickbacks to physicians to prescribe Biogen drugs, the U.S. Justice Department said Sept. 26. The False Claims lawsuits alleged that Biogen submitted false claims to Medicare and Medicaid by paying kickbacks to its top physician prescribers to dissuade them from prescribing drugs from competitors. The lawsuit was filed in Massachusetts in 2012 by whistleblower and former employee Michael Bawduniak. According to the complaint, from Jan. 1, 2009, to March 18, 2014, the company paid remuneration — including in the form of speaker honoraria, speaker training fees, consulting fees and meals — to physicians who attended their speaker programs or consultant programs to induce them to prescribe Avonex, Tysabri and Tecfidera. Biogen will pay $843.8 million to the U.S. and $56.2 million to 15 states. Mr. Bawduniak will receive approximately 29.6 percent of the settlement's federal proceeds. n

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