On the finish of final yr, CMS finalized a price lower for Medicare reimbursement to physicians. The CMS Truth Sheet states:
…common fee charges underneath the PFS [Physician Fee Schedule] will probably be diminished by 2.93% in CY 2025, in comparison with the typical quantity these companies have been paid for many of CY 2024
This appears like a modest pay lower, however the American Medical Affiliation the true impression is even bigger. CMS experiences that the Medicare Financial Index (MEI)–a measure of apply price inflation from workers salaries and wages, workplace house, provides and malpractice–elevated by 3.5%. Thus, with reimbursement falling and apply price 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 only one% in 2027, it is going to develop to 10.5% over a number of a long time.
MedPAC writes:
Traditionally, the Fee has discovered that Medicare beneficiaries had related entry to care relative to the privately insured, however the bigger hole between MEI development and PFS updates might negatively have an effect on beneficiary entry sooner or later.
Joe Paduda agrees with this evaluation.
