CMS proposed physician payment rule 2023

[Linktones]

Any guesses on how this would be implemented if it goes through?

CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care | CMS

The Centers for Medicare & Medicaid Services (CMS) today issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in...

www.cms.gov

“CMS is also proposing to bundle certain chronic pain management and treatment services into new monthly payments, improving patient access to team-based comprehensive chronic pain treatment. Lastly, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.”

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[lobelsteve]

Any guesses on how this would be implemented if it goes through?

CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care | CMS

The Centers for Medicare & Medicaid Services (CMS) today issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in...

www.cms.gov

“CMS is also proposing to bundle certain chronic pain management and treatment services into new monthly payments, improving patient access to team-based comprehensive chronic pain treatment. Lastly, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.”

 

[TheLoneWolf]

Vans giving sublocade to the rural and homeless.

Or vans full of opioids getting burglarized.

 

[MitchLevi]

Wait...Specifically what vans and who is paying for that gas money? Sprinter van? Plain, white Ford van?

The enemy of good is perfect, and I'm okay with a van I guess...So many Q though.

I see crime involved...Van robberies.

 

[powermd]

Can't wait to see the cuts they have in store for us next year.

 

[geauxg8rs]

Any guesses on how this would be implemented if it goes through?

CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care | CMS

The Centers for Medicare & Medicaid Services (CMS) today issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in...

www.cms.gov

“CMS is also proposing to bundle certain chronic pain management and treatment services into new monthly payments, improving patient access to team-based comprehensive chronic pain treatment. Lastly, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.”

I am sure it will go like everything does with Pain and CMS. It will be some type of boondoggle for some unscrupulous docs who make millions. Then they get fined. A la urine tox.
Then CMS does cost saving things like limiting facet to one level payment of 250 no matter how many levels you do.

Or something similar

 

[geauxg8rs]

Can't wait to see the cuts they have in store for us next year.

When CMS spoke at asipp in 2021 the ladies there said that CMS is not allowed to consider cost when amending these LCDs. Strange though that things never get expanded, only more limited and at a bigger cost save for the gubment.

I am just glad that inflation is only transitory so we can afford to be paid less. 😂

 

[buddababa]

This cms budget neutral thing has got to go. Getting penalized for being productive audited for working hard. All of this is just terrible.

 

[bedrock]

As I mentioned in the other thread, these cuts every year are becoming unsustainable.

How is it remotely fair to cut our pay by 4% every year when our costs are increasing by double that amount or more every year?

And unfortunately patients on federal insurance, Medicare , tricare, and Medicaid don’t understand how poorly their plans pay.

My most annoying patients are rich patients on Medicare who behave as if they are paying cash for everything instead of the government paying us basically Medicaid rates.

I plan to soon limit my federal government patients of all types to just a few per day.

Time spent on federal patients is becoming charity care for all of them, not just Medicaid patients

 

[DOctorJay]

This cms budget neutral thing has got to go. Getting penalized for being productive audited for working hard. All of this is just terrible.

Can someone explain “budget neutral” when physician fees never go up but facility fees increase significantly every year?

 

[BobBarker]

I don’t think private insurance pays more than Medicare here with much, much more hassle. I could have a practice filled with traditional Medicare and Medicaid patients and do great.

 

[bedrock]

I don’t think private insurance pays more than Medicare here with much, much more hassle. I could have a practice filled with traditional Medicare and Medicaid patients and do great.

Don’t you work for a hospital?

 

[BobBarker]

I have a job where I work for the hospital 4 days per week. 1 day per week I have a private practice.

 

[bedrock]

I agree that most Medicare patients are easier to treat than most commercial patients.
But some Medicare and most Medicaid patients can still be demanding.

This financial discussion doesn’t apply nearly as much to hospital based docs as you receive 130% Medicare for clinic appts and double ASC facility fees for fluoro procedures, so yes you’ll do fine financially seeing Medicare and Medicaid due to SOS.

For those of us in pp, not so much.

My practice has good commercial and WC contracts that pay well above Medicare. So every time CMS cuts Medicare rates, I debate how much longer I will still accept it.

 

[BobBarker]

Most hospital based physicians bill the office rate for office visits here. The only place I know of that bills the facility fee and then the physician fee is the university.

 

[drusso]

Can someone explain “budget neutral” when physician fees never go up but facility fees increase significantly every year?

That's not an accident. It's by design and was a big part of Obama-Care. Remember, "Elections have consequences." And, "They will never love you back."

Facility fees are ruining quality care

We must eliminate the crushing facility fee to level the playing field.

www.kevinmd.com

 

[BSM_OTO]

Can someone explain “budget neutral” when physician fees never go up but facility fees increase significantly every year?

it's blatant corruption

news and public screams and cries about the expensive healthcare system

gov't reacts by cutting doctor reimbursements (prof fees)

while facility fees that go to admins and tycoons stay real juicy, and even go up (facility fees, the real problem)

when in reality, the reason we have 5-6fig hospital bills as the norm and honestly everything is just expensive is due to FACILITY fees, not the prof fees.

it's literally manipulation. they're attacking the little guys (the docs just trying to keep their lights on and outcompete a hospital salary) and framing it as if they're attacking the big guys.

this is undebatable imo, i'd love to hear an argument against this.

and then hospitals pay physicians on salary or give them contracts of lump sums disguised as *admin* positions or something (chief of pain, director of pain) which requires little work but is essentially kicking back some of the facility fee to the doc to keep them doing the procedures at their HOPD rather than asc/office. I know of docs personally that have this setup. but is CMS gonna go after a hospital system? never! how could they? they're a nonprofit! that pays dozens of people 7-8 fig salaries! (yes 8fig near me) how could they be doing anything wrong, as a nonprofit!


so in reality, the current direction it's going in will actually increase costs. more and more docs are moving to hopd procedures (overall increase in cost due to procedures being done at more expensive SOS) and hopping on salary (just a kickback) because the prof fees are getting cut, and hospitals can actually pay physicians a **** ton of money and still profit a ton because of the THICC facility fees to HOPD.

the question is, is somebody gonna do anything about it, before it's too late?

 

[TheLoneWolf]

it's blatant corruption

news and public screams and cries about the expensive healthcare system

gov't reacts by cutting doctor reimbursements (prof fees)

while facility fees that go to admins and tycoons stay real juicy, and even go up (facility fees, the real problem)

when in reality, the reason we have 5-6fig hospital bills as the norm and honestly everything is just expensive is due to FACILITY fees, not the prof fees.

it's literally manipulation. they're attacking the little guys (the docs just trying to keep their lights on and outcompete a hospital salary) and framing it as if they're attacking the big guys.

this is undebatable imo, i'd love to hear an argument against this.

and then hospitals pay physicians on salary or give them contracts of lump sums disguised as *admin* positions or something (chief of pain, director of pain) which requires little work but is essentially kicking back some of the facility fee to the doc to keep them doing the procedures at their HOPD rather than asc/office. I know of docs personally that have this setup. but is CMS gonna go after a hospital system? never! how could they? they're a nonprofit! that pays dozens of people 7-8 fig salaries! (yes 8fig near me) how could they be doing anything wrong, as a nonprofit!


so in reality, the current direction it's going in will actually increase costs. more and more docs are moving to hopd procedures (overall increase in cost due to procedures being done at more expensive SOS) and hopping on salary (just a kickback) because the prof fees are getting cut, and hospitals can actually pay physicians a **** ton of money and still profit a ton because of the THICC facility fees to HOPD.

the question is, is somebody gonna do anything about it, before it's too late?

@drusso is that you?

 

[DOctorJay]

it's blatant corruption

news and public screams and cries about the expensive healthcare system

gov't reacts by cutting doctor reimbursements (prof fees)

while facility fees that go to admins and tycoons stay real juicy, and even go up (facility fees, the real problem)

when in reality, the reason we have 5-6fig hospital bills as the norm and honestly everything is just expensive is due to FACILITY fees, not the prof fees.

it's literally manipulation. they're attacking the little guys (the docs just trying to keep their lights on and outcompete a hospital salary) and framing it as if they're attacking the big guys.

this is undebatable imo, i'd love to hear an argument against this.

and then hospitals pay physicians on salary or give them contracts of lump sums disguised as *admin* positions or something (chief of pain, director of pain) which requires little work but is essentially kicking back some of the facility fee to the doc to keep them doing the procedures at their HOPD rather than asc/office. I know of docs personally that have this setup. but is CMS gonna go after a hospital system? never! how could they? they're a nonprofit! that pays dozens of people 7-8 fig salaries! (yes 8fig near me) how could they be doing anything wrong, as a nonprofit!


so in reality, the current direction it's going in will actually increase costs. more and more docs are moving to hopd procedures (overall increase in cost due to procedures being done at more expensive SOS) and hopping on salary (just a kickback) because the prof fees are getting cut, and hospitals can actually pay physicians a **** ton of money and still profit a ton because of the THICC facility fees to HOPD.

the question is, is somebody gonna do anything about it, before it's too late?

Physician salaries account for 8% of healthcare costs.

Think about that.

They could literally pay us nothing and it wouldn’t even put a dent in healthcare costs.

 

[lobelsteve]

Physician salaries account for 8% of healthcare costs.

Think about that.

They could literally pay us nothing and it wouldn’t even put a dent in healthcare costs.

Don't give them any more ideas.

 

[Gauss]

seeing a big push by fed and state government agencies going all in on managed care programs for medicare and medicaid. Kaiser just got a monster no-bid contract here in CA California inks sweetheart deal with Kaiser Permanente, jeopardizing Medicaid reforms

 

[drusso]

@drusso is that you?

No, but it's spot-on and a beautiful analysis.

 

[Ducttape]

can anyone look at the Fee schedule on ASIPP and report how much facility fee costs have gone up since 2020? access is allowed to the 2020 numbers, but not after.

facility fees went up across the board from 2018 to 2020. would like to see how they compare to 2021 to 2023.


the other side of the coin - more and more hospitals are closing, even with the perceived rise of hospital facility fees.

State-by-state breakdown of 897 hospitals at risk of closing

More than 500 rural hospitals in the U. S. were at immediate risk of closure before the COVID-19 pandemic because of financial losses and lack of reserves to maintain operations, according to a report from the Center for Healthcare Quality and Payment Reform.

www.beckershospitalreview.com

Heartland Hospitals in U.S. Face Wipeout With 800 at Risk of Shutdown

Pummeled by the pandemic, at least 40% of rural U.S. hospitals are in danger of shutting down and leaving millions of people in smaller and less affluent communities without a nearby emergency and critical care facility.

www.bloomberg.com

 

[Pain Applicant1]

As I mentioned in the other thread, these cuts every year are becoming unsustainable.

How is it remotely fair to cut our pay by 4% every year when our costs are increasing by double that amount or more every year?

And unfortunately patients on federal insurance, Medicare , tricare, and Medicaid don’t understand how poorly their plans pay.

My most annoying patients are rich patients on Medicare who behave as if they are paying cash for everything instead of the government paying us basically Medicaid rates.

I plan to soon limit my federal government patients of all types to just a few per day.

Time spent on federal patients is becoming charity care for all of them, not just Medicaid patients

Does not matter if it's fair. All's fair. Outcomes are all that matters. If they cut your pay and medicare pts continue to be seen by doctors then they did great. Supply and demand. If they cut your pay and doctors stop accepting medicare and pts complain then that's another issue. The latter won't happen because most commercials will follow medicare rates and you have little leverage in negotiating if you're a little guy.

My wife as an attorney used to help with some budget thing in NYC. They would literally discuss things like what's the most you can tax people before you have negative consequences e.g. rich moving elsewhere. They try to tax right below that threshold.

 

[DrMDAware]

Does not matter if it's fair. All's fair. Outcomes are all that matters. If they cut your pay and medicare pts continue to be seen by doctors then they did great. Supply and demand. If they cut your pay and doctors stop accepting medicare and pts complain then that's another issue. The latter won't happen because most commercials will follow medicare rates and you have little leverage in negotiating if you're a little

Perhaps we are nearing the point where patients start to complain. I’ve had multiple private physicians stop accepting Medicare in my area. There is a very large healthcare organization that does accept Medicare. However the wait times essentially makes it like they don’t accept the insurance.
Just seems like something has to give soon.

Either
1. Large healthcare organizations incentivize their staff to see more patients (unlikely)
2. More physicians join large healthcare organization (maybe if the pay and benefits are right)
3. More midlevelers are hired in pain to see the patients (esp in the private sector)

 

[RoloTomassi]

Getting rid of facility fees is never going to happen. The answer is for doctors to stop taking the easy money from the hospitals, take the risk and build ASCs, take back the power. And when insurers and patients get sick of paying HOPD rates, more will shift to physician-owned ASCs.

 

[Pain Applicant1]

Perhaps we are nearing the point where patients start to complain. I’ve had multiple private physicians stop accepting Medicare in my area. There is a very large healthcare organization that does accept Medicare. However the wait times essentially makes it like they don’t accept the insurance.
Just seems like something has to give soon.

Possibly but I don't think so. There will always be people like me who would likely take in those pts even if I got paid less. Not for altruistic reasons by any means - I would just adapt my business plan around that.

Either
1. Large healthcare organizations incentivize their staff to see more patients (unlikely)
2. More physicians join large healthcare organization (maybe if the pay and benefits are right)
3. More midlevelers are hired in pain to see the patients (esp in the private sector)

I vote #3 as the likely scenario, especially as it's already happening. Most pts don't know or even care who or what they're seeing.

I don't care enough to be pro physician but during my last appointment, I requested to be seen by a physician, not an NP. What a hypocrite I am, lol.

 

[mid|ine]

Time to talk with my group again about PE sale. A 12x EBITDA payments sounds really good.

 

[nvrsumr]

More McMedicine is the only real answer. Higher volume utilizing lower cost providers. Yes, PAs and NPs doing pain procedures on govt insured patients. In PP I cant pay a doc 775k year with 10 weeks vacation so cant compete with the hospitals. When I am ready to slow down I doubt I could afford to hire an MD to pick up the slack.

 

[Agast]

More McMedicine is the only real answer. Higher volume utilizing lower cost providers. Yes, PAs and NPs doing pain procedures on govt insured patients. In PP I cant pay a doc 775k year with 10 weeks vacation so cant compete with the hospitals. When I am ready to slow down I doubt I could afford to hire an MD to pick up the slack.

Where are they paying $775k with 10 weeks vacation? Asking for a friend

 

[RaceCanyon]

Where are they paying $775k with 10 weeks vacation? Asking for a friend

Can I be your friend?

 

[bedrock]

More McMedicine is the only real answer. Higher volume utilizing lower cost providers. Yes, PAs and NPs doing pain procedures on govt insured patients. In PP I cant pay a doc 775k year with 10 weeks vacation so cant compete with the hospitals. When I am ready to slow down I doubt I could afford to hire an MD to pick up the slack.

Lol, I’m not sure all HOPD pain docs make 775K with 10 weeks of vacation these days??

Some docs also prioritize their professional freedom enough to work more for less $$ in PP.

 

[nvrsumr]

The gas forums have a current thread on past compensation and there is a post by a pain doc stating that number as current salary. That may be an outlier but the trends are moving toward HOPd being a better financial deal.

Plus it sounds hard to find a really fair PP where the younger docs are equal partners resulting in real professional freedom..

 

[drusso]

Where are they paying $775k with 10 weeks vacation? Asking for a friend

It's all juice from the HOPD vig. Their just moving money from the facility side to the MD side.

 

[Ducttape]

is there a problem with paying HOPD docs a good salary?

 

[drusso]

is there a problem with paying HOPD docs a good salary?

Rapid rise in hospital-employed physicians increases costs

The number of hospital-employed physicians hit about 155,000 in 2016, up 63% from 95,000 in 2012, a trend that could be eroding competitive market forces and inflating costs.

www.modernhealthcare.com

"What we can't understand is the value proposition for the physicians in the long run," James said. "If they buy us, it is going to add a bunch of overhead and increase the cost of care." Wilmington stands out during a time of rapid consolidation in the healthcare industry, particularly among physician groups. Healthcare experts caution that healthcare costs will rise as more hospitals acquire physician groups.

Medicare Spends $3.1B More on Hospital-Employed Physicians

A new study uncovered that Medicare spending on four common services increased with more hospital-employed physicians.

revcycleintelligence.com

"Hospital inpatient and outpatient departments typically receive greater Medicare reimbursement rates for services compared to ambulatory surgical centers and physician offices. The rates are higher for hospital-based care because the providers can bill for facility costs, whereas independent physicians bill Medicare at the non-facility rate. Therefore, Medicare spends more for hospital-based care. For example, a colonoscopy would cost Medicare 164 percent more if provided in a hospital outpatient department or ambulatory surgical center versus an independent physician’s office, researchers reported."

Physician-Hospital Integration Increases Costs, Study Finds

Physician-hospital integration is associated with increased costs and resource use without care quality improvements, a new study from Rice University and Blue Cross and Blue Shield of Texas showed.

revcycleintelligence.com

"Costs were 5.8 percent higher for patients treated by doctors in hospital- versus physician-owned practices, a new study of physician-hospital integration shows."

Rising costs, low-value care linked to hospital-employed physicians, studies show

Hospital-employed physicians were more likely to refer patients to hospital-based services, including inappropriate MRIs, two new studies found.

www.modernhealthcare.com

"The odds of a patient receiving an inappropriate MRI scan for lower back, knee or shoulder pain increased by more than 20% after an independent primary-care doctor transitioned to hospital employment, researchers found. Most patients were referred to the hospital where the physician was employed."

Most health systems still base doctors' pay on volume, despite push toward value-based care: study

Despite the growth in value-based payment arrangements from payers, health systems continue to pay physicians based on the volume of services they provide. | Despite the growth in value-based payment arrangements from payers, health systems continue to pay physicians based on the volume of...

www.fiercehealthcare.com

“Despite growth in value-based programs and the need to improve value in health care, physician compensation arrangements in health systems do not currently emphasize value,” said Rachel O. Reid, M.D., the study’s lead author and a physician policy researcher at RAND, a nonprofit research organization. “The payment systems that are most often in place are designed to maximize health system revenue by incentivizing providers within the system to deliver more services," Reid said in a statement."

 

[Ducttape]

so HOPD doctors are not allowed to make money, only PP docs.

thanks for the clarification.



fyi if it makes you feel better, i can guarantee you that my salary is significantly under 50% MGMA.

 

[lobelsteve]

so HOPD doctors are not allowed to make money, only PP docs.

thanks for the clarification.



fyi if it makes you feel better, i can guarantee you that my salary is significantly under 50% MGMA.

Too bad, so sad. Work for Drusso and become a russilionaire.

 

[SSdoc33]

Too bad, so sad. Work for Drusso and become a russilionaire.

but, you have to RF cluneal nerves and PRP everything with a pulse

 

[Ducttape]

he would be my employer. if HOPD employed docs cant make money, should private practice employed docs?



btw, what is the exchange rate of russiolions to US dollars? is it better than 2 bits or equal to a ducat?

 

[Doctodd]

Rapid rise in hospital-employed physicians increases costs

The number of hospital-employed physicians hit about 155,000 in 2016, up 63% from 95,000 in 2012, a trend that could be eroding competitive market forces and inflating costs.

www.modernhealthcare.com

"What we can't understand is the value proposition for the physicians in the long run," James said. "If they buy us, it is going to add a bunch of overhead and increase the cost of care." Wilmington stands out during a time of rapid consolidation in the healthcare industry, particularly among physician groups. Healthcare experts caution that healthcare costs will rise as more hospitals acquire physician groups.

Medicare Spends $3.1B More on Hospital-Employed Physicians

A new study uncovered that Medicare spending on four common services increased with more hospital-employed physicians.

revcycleintelligence.com

"Hospital inpatient and outpatient departments typically receive greater Medicare reimbursement rates for services compared to ambulatory surgical centers and physician offices. The rates are higher for hospital-based care because the providers can bill for facility costs, whereas independent physicians bill Medicare at the non-facility rate. Therefore, Medicare spends more for hospital-based care. For example, a colonoscopy would cost Medicare 164 percent more if provided in a hospital outpatient department or ambulatory surgical center versus an independent physician’s office, researchers reported."

Physician-Hospital Integration Increases Costs, Study Finds

Physician-hospital integration is associated with increased costs and resource use without care quality improvements, a new study from Rice University and Blue Cross and Blue Shield of Texas showed.

revcycleintelligence.com

"Costs were 5.8 percent higher for patients treated by doctors in hospital- versus physician-owned practices, a new study of physician-hospital integration shows."

Rising costs, low-value care linked to hospital-employed physicians, studies show

Hospital-employed physicians were more likely to refer patients to hospital-based services, including inappropriate MRIs, two new studies found.

www.modernhealthcare.com

"The odds of a patient receiving an inappropriate MRI scan for lower back, knee or shoulder pain increased by more than 20% after an independent primary-care doctor transitioned to hospital employment, researchers found. Most patients were referred to the hospital where the physician was employed."

Most health systems still base doctors' pay on volume, despite push toward value-based care: study

Despite the growth in value-based payment arrangements from payers, health systems continue to pay physicians based on the volume of services they provide. | Despite the growth in value-based payment arrangements from payers, health systems continue to pay physicians based on the volume of...

www.fiercehealthcare.com

“Despite growth in value-based programs and the need to improve value in health care, physician compensation arrangements in health systems do not currently emphasize value,” said Rachel O. Reid, M.D., the study’s lead author and a physician policy researcher at RAND, a nonprofit research organization. “The payment systems that are most often in place are designed to maximize health system revenue by incentivizing providers within the system to deliver more services," Reid said in a statement."

my local MRI center charges $350 for a lumbar spine MRI. The hospital charges 5-10x that. There is no rationale except the suits and the lobbying(legal money laundering) money hospitals spend.

 

[lobelsteve]

he would be my employer. if HOPD employed docs cant make money, should private practice employed docs?



btw, what is the exchange rate of russiolions to US dollars? is it better than 2 bits or equal to a ducat?

There is an RVU conversion.

Russo Vaginal Umami's.
Emotional attachment therapy and a support ferret required.

 

[drusso]

Too bad, so sad. Work for Drusso and become a russilionaire.

 

[drusso]

There is an RVU conversion.

Russo Vaginal Umami's.
Emotional attachment therapy and a support ferret required.

 

[ateria radicularis magna]

There is an RVU conversion.

Russo Vaginal Umami's.
Emotional attachment therapy and a support ferret required.

Serious question—would you allow a support ferret in the office?

 

[nvrsumr]

Youre not even allowed to ask for support ferret paperwork

 

[Doctodd]

Only if it has been de-scented. They can smell really bad if not washed regularly. They are members of the skunk family I think. They are super cute and smart otherwise.

 

[lobelsteve]

Serious question—would you allow a support ferret in the office?

Dogs yes, but not in procedure suite. Ferret no. Sugar glider- absolutely- and I have a patient who has 10 of them. Begging her to bring one in.

 

[Gauss]

Dogs yes, but not in procedure suite. Ferret no. Sugar glider- absolutely- and I have a patient who has 10 of them. Begging her to bring one in.

broadcasting my current vibe

 

[drusso]

View attachment 357136
broadcasting my current vibe

My current vibe...