Details on the MPFS changes

In the MPFS final rule, CMS decreased MPFS' conversion factor by 3.4%, which will lead to a 1.25% reduction in Medicare reimbursements next year.

However, family physicians stand to see gains from the full implementation of a new billing code that will increase payments for complex patient office visits.

The rule also expands behavioral health services and prioritizes "whole-person" health. It will allow marriage and family therapists and mental health counselors who meet qualification requirements to enroll in Medicare for the first time and start billing for services starting January 1, 2024. It also increases payment for crisis care, substance use disorder treatment, and psychotherapy.

For the Quality Payment Program, CMS finalized the creation of five new, optional Merit-based Incentive Payment System Value Pathways for reporting beginning in 2024.

Reaction to MPFS changes

In a press release, CMS said the rule will "support primary care, advance health equity, assist family caregivers, and expand access to behavioral and certain oral health care ... [The] final rule also provides payment for principal illness navigation services to help patients and their families navigate cancer treatment and treatment for other serious illnesses."

However, Chip Kahn, CEO of the Federation for American Hospitals, said the MPFS rule "erodes the ability of hospitals to deliver lifesaving services that patients depend on, especially in rural areas where many hospitals are already struggling to survive."

"The Medicare physician payment schedule released today is an unfortunate continuation of a two-decade march in making Medicare unsustainable for patients and physicians," said American Medical Association President Jesse Ehrenfeld. "This is a recipe for financial instability. Patients and physicians will wonder why such thin gruel is being served."

Anders Gilber, SVP of government affairs for the Medical Group Management Association, said CMS' rule "further [increases] the gap between physician practice expenses and reimbursement rates, and dangerously [impedes] beneficiary access to care."

Similarly, Jerry Penso, president and CEO of the American Medical Group Association (AMGA), said, "Those who look at the current payment system and believe the reimbursement rate announced today is sufficient are ignoring the fiscal pressures and increased care demands AMGA members are currently facing."

Details on OPPS changes

CMS' OPPS final rule will provide a 3.1% payment increase, up from the 2.8% increase proposed over the summer.

CMS also finalized several changes regarding price transparency, including a requirement that hospitals make cost data publicly available in a more standardized manner, which CMS said will make it easier for third-party developers to use and simpler for patients to parse through.

In addition, the rule finalized proposals streamlining price transparency, with CMS saying it will reserve the right to directly communicate with hospital leadership if their price transparency performance is insufficient, and that enforcement measures will be posted online.

The rule will also finalize provisions from the Consolidated Appropriations Act of 2023, which will create a new benefit category for intensive outpatient services provided to behavioral health patients.

Reaction to OPPS changes

CMS Administrator Chiquita Brooks-LaSure said the final rule "strengthens hospital price transparency by improving the standardization of hospital standard charges and enhancing CMS' enforcement capabilities, thereby better enabling the American people to understand and meaningfully use hospital standard charges for items and services."

Meanwhile, HHS Secretary Xavier Becerra said the rule "will fill longstanding gaps in behavioral health treatment for Medicare beneficiaries."

However, American Hospital Association (AHA) VP Stacey Hughes said AHA "is concerned that CMS has again finalized an inadequate update to hospital payments," adding that the 3.1% payment increase "comes in spite of persistent financial headwinds facing the field."

"Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day," Hughes said. "Hospitals' and health systems' ability to continue caring for patients and providing essential services for their communities may be in jeopardy, which is why the AHA is urging Congress for additional support by the end of the year." (Goldman, Axios, 11/3; Bennett, Modern Healthcare, 11/2; Minemyer, Fierce Healthcare, 11/2; AHA News, 11/2; Brooks, Medscape, 11/3; Frieden, MedPage Today, 11/3; American Hospital Association, 11/2)