On the finish of final 12 months, CMS finalized a price reduce for Medicare reimbursement to physicians. The CMS Reality Sheet states:
…common fee charges beneath the PFS [Physician Fee Schedule] will likely be decreased by 2.93% in CY 2025, in comparison with the typical quantity these companies had been paid for many of CY 2024
This seems like a modest pay reduce, however the American Medical Affiliation the actual impression is even bigger. CMS experiences that the Medicare Financial Index (MEI)–a measure of observe price inflation from employees salaries and wages, workplace area, provides and malpractice–elevated by 3.5%. Thus, with reimbursement falling and observe price rising the actual reimbursement discount is nearer to six.7% actual reimbursement discount.
Why is CMS doing this? MedPAC notes that CMS could also be aiming to drive down reimbursement for physicians in conventional Medicare fee-for-service with the intention to shift them to superior various fee fashions (A-APM). Whereas the reimbursement differential between FFS and A-APM physicians is just one% in 2027, it’ll develop to 10.5% over a number of a long time.
Traditionally, the Fee has discovered that Medicare beneficiaries had comparable entry to care relative to the privately insured, however the bigger hole between MEI progress and PFS updates might negatively have an effect on beneficiary entry sooner or later.
Joe Paduda agrees with this evaluation.
