If CR passes, it will erase (most of) the CMS physician pay cut (UPDATE: It didn't!)

UPDATE 12/21: In the continuing resolution finally enacted by Congress and signed by the President on Dec. 20, the COVID-era  telehealth flexibilities were extended through March 2025 -- not for two years as originally proposed -- and the physician pay cut was left unaddressed. Watch Part B News for more developments. 

 

Unless blocked by pressure from the President-elect, Congress appears ready to pull the trigger on a continuing resolution (CR) that would boost physician pay under Medicare, currently facing a cut, to something close to the current status quo.

 

Donald Trump is reportedly trying to scuttle the bill, some version of which is needed by Saturday to prevent a government shutdown. At this writing it remains to be seen whether Speaker of the House Johnson and Republican House members will capitulate. 

 

The current Congressional markup -- posted, among other places, at Punchbowl News -- includes a "Temporary Payment Increase Under The Medicare Physician Fee Schedule To Account For Exceptional Circumstances" section (see p. 464, section 205) that would boost the conversion factor, cut by nearly 2.8% in the 2025 Physician Fee Schedule final rule, by 2.5%, a net loss of less than 0.3%.

 

The CR would also extend through 2026 the telehealth flexibilities that were set to expire at the end of this year.

On behalf of the Medical Group Management Association (MGMA), its senior vice president for government affairs Anders Gilberg called the CR a "mixed bag for medical groups." They are dissatisfied with the pay boost: "Any cut, however fractional, is unacceptable."

 

On the other hand, MGMA is pleased with the telehealth extension -- and with the increase in Advanced APM (alternative payment model) incentive payments under the Quality Payment Program. These were mired at 1.88%, but would be raised under the CR to 3.53% through 2027. 

 

Aisha Pittman, senior vice president of government affairs of NAACOS (the National Association of ACOs), also expressed appreciation of the APM adjustment, and says NAACOS "looks forward to working with Congress to craft a sustainable, long-term approach to physician payment reform that supports the transition to high-value, patient-centered care."

 

The CR would also extend the 1.0 Medicare work GPCI floor. This is a story in progress; more at Part B News as it develops.