On the finish of final yr, CMS finalized a fee lower for Medicare reimbursement to physicians. The CMS Reality Sheet states:
…common cost charges underneath the PFS [Physician Fee Schedule] can be decreased by 2.93% in CY 2025, in comparison with the common quantity these providers had been paid for many of CY 2024
This appears like a modest pay lower, however the American Medical Affiliation the actual impression is even bigger. CMS reviews that the Medicare Financial Index (MEI)–a measure of observe price inflation from employees salaries and wages, workplace house, provides and malpractice–elevated by 3.5%. Thus, with reimbursement falling and observe price rising the actual 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 to be able to shift them to superior different cost 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 a long time.
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 may negatively have an effect on beneficiary entry sooner or later.
Joe Paduda agrees with this evaluation.
