On the finish of final 12 months, CMS finalized a charge lower for Medicare reimbursement to physicians. The CMS Reality Sheet states:
…common fee charges underneath the PFS [Physician Fee Schedule] can be diminished by 2.93% in CY 2025, in comparison with the common quantity these companies had been paid for many of CY 2024
This appears like a modest pay lower, however the American Medical Affiliation the true influence is even bigger. CMS studies that the Medicare Financial Index (MEI)–a measure of apply value inflation from employees salaries and wages, workplace house, provides and malpractice–elevated by 3.5%. Thus, with reimbursement falling and apply value rising the true 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 in an effort to shift them to superior different 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 many years.
Traditionally, the Fee has discovered that Medicare beneficiaries had related 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.