2023 MPFS Proposed Rule: Impact on Anesthesia
Summary: The government releases its proposed Medicare fee schedule for 2023. It's a mixed bag for anesthesia providers.
It's one thing to propose; it's another to follow through. When a plan is accepted and put into action, the planners can look back with pride on the day their proposals were first put down on the drawing board. Proposals are important because they are the starting point of fruition and culmination. Just as every marriage begins with a proposal, so every government regulation begins with a proposed rule. With this principle firmly in hand, let us now consider the latest proposals emanating from Washington that are bound to have significant implications for the anesthesia community.
On July 7, the Centers for Medicare & Medicaid Services (CMS) issued its 2023 Medicare Physician Fee Schedule (PFS) proposed rule (PR), which purports to communicate what the government has planned as it concerns Medicare Part B payment conditions and related requirements. As part of its rule rollout, CMS also released a fact sheet, outlining some of the key provisions of the PR. From these sources, we are providing below a summary of the issues that will have an impact on our anesthesia clients.
Reimbursement Concerns
For those who did not see our special alert on July 8, we will reiterate here that the PR does contain a cut in both the PFS conversion factor (CF) and the anesthesia CF. The PR sets the PFS CF to $33.08 in 2023, as compared to $34.61 in 2022, reflecting a 4.4 percent decrease. The reduction is based on the following factors:
• The expiration of the three-percent statutory payment increase;
• A zero-percent CF update; and
• A budget-neutrality adjustment.
The anesthesia CF for 2023 is set at $20.71, according to the PR. This represents a drop from the current year's anesthesia CF of $21.56, reflecting a 3.9 percent decrease in reimbursement for anesthesia services in the upcoming year.
If these cuts stand, they will represent one more financial hit to those already facing difficulty in maintaining their income levels and attracting new recruits. Some areas may fare better than others in this regard since these CFs fluctuate in actual value based on geographical location. In other words, some will receive reimbursement based on a higher CF than their counterparts in other cities, regions and states. These geographical CF variations are based on the perceived practice cost differentials that the government has calculated and determined to exist throughout the country.
The American Society of Anesthesiologists (ASA) weighed in on the proposed cut in the anesthesia CF. In a press release on July 8, it stated the following:
ASA opposes these additional Medicare payment cuts included in the CY 2023 PFS proposed rule. The proposed rule underscores how the Medicare payment system is broken, especially during a time when anesthesia groups are faced with inflation pressures and the COVID-19 pandemic. ASA has urged and will continue to advocate to legislative stakeholders and regulatory agencies to minimize and reverse these cuts that negatively impact anesthesiologists.
Finally, we should point out that these reductions in the PFS and anesthesia CFs are in addition to the two-percent sequestration cut, which was scheduled to resume on July 1, as well as the four-percent PAYGO cut, which will be effective January 1 of next year—assuming there is no congressional intervention. All told, anesthesia providers could experience an approximate 10 percent reduction in Medicare reimbursement levels, beginning in 2023.
Ultrasound Bundled
We knew this day was coming, but it appears that, beginning January 1, 2023, block codes 64415-64417 and 64445-64448 will be revised to "include ultrasound guidance (USG), when performed." This is based on both the PR and a review of the AMA CPT Editorial Panel Actions. According to the ASA, USG (CPT 76942) is reported in addition to these codes in over 75 percent of such cases, based on the organization's tracking the incidence of USG usage over the last few years.
If this proposal holds, anesthesia providers will no longer be able to charge additionally for USG relative to these particular blocks. Here is a chart outlining the work value differentials relative to current and the proposed 2023 block payments that our readers may find helpful:
From the above, you can see that the proposal would increase the work relative value unit (RVU) for all block codes bundling USG, except for CPT 64415 (Injection, anesthetic agent; brachial plexus, single). So, on the upside, the reimbursement for these codes should be adjusted upward next year to reflect the USG work value component. For now, we recommend providers continue to support their USG services by continuing to include attestations of retained images and report verbiage, where applicable.
Colorectal Cancer Screening
CMS, in the 2023 PR is proposing to expand Medicare coverage for certain colorectal cancer screening tests by reducing the minimum age payment limitation to 45 years. The agency is also proposing to expand the regulatory definition of colorectal cancer screening tests to include a follow-on screening colonoscopy after a Medicare covered non-invasive stool-based colorectal cancer screening test returns a positive result.
Quality Payment Program
For the 2023 reporting year, CMS is proposing to maintain the performance threshold at 75 points. Scoring above this mark would allow an individual or group a payment bonus while scoring below 75 points would result in a payment penalty in 2025. The exceptional performance bonus is not available for the 2025 payment year. In addition:
• The quality performance category will be weighted at 30 percent and the cost performance category will be weighted by 30 percent. Promoting interoperability and Improvement Activities performance categories will maintain their respective 25 percent and 15 percent weights.
• The PR would increase the data completeness threshold to 75 percent for 2024 and 2025 performance periods. The threshold in the MIPS Quality Performance Category remains at 70 percent for 2023 performance year.
• CMS has proposed to remove MIPS 76 (Prevention of Central Venous Catheter (CVC) – Related Bloodstream Infections) from MIPS and the Anesthesiology Measure Set. CMS has proposed the inclusion of a new measure, Screening for Social Drivers of Health in the measure set. No other changes were made to the Anesthesiology Specialty Measure set.
Anesthesiologists will have the opportunity to report the Anesthesiology MIPS Value Pathway in 2023. MIPS Value Pathways, CMS believes, will alleviate some of the reporting burdens that anesthesiologists and other physicians encounter in the MIPS program.
For more information on the Quality Payment Program, you may contact the ASA Department of Quality and Regulatory Affairs (QRA) at qra@asahq.org. You can also reach out to your account executive or contact us at info@anesthesiallc.com for any questions pertaining to the PR.