On November 2nd, the Centers for Medicare and Medicaid Services released the Calendar Year (CY) 2024 Physician Fee Schedule Final Rule. The finalizing of the impact to physician payment and other outpatient services covered under Medicare Part B is significant for physicians.

A lot of information and change is packed within the narrative of the final rule.  One epochal element of the proposed rule cuts the conversion factor by 3.4% to $32.74 from $33.89 CY 2023. The reduction represents an impact of $1.15 conversion factor reduction. The calculation is based on four separate factors:

  • Sunsetting of the 2.5% statutory payment increase from CY 2023
  • 25% statutory increase for CY 2024
  • 0% conversion factor update for the Medicaid and Children’s Health Insurance Program (CHIP)
  • Budget neutrality adjustment

The Final Rule was further packed with various program changes that perhaps serve as direct insight to what Medicare may be thinking about physician reimbursement. Other key elements of changes include but are not limited to:

  • Adding 5 new optional Merit-based Incentive Payment Pathways (MIPS)
  • Parameters to address “whole person care” via telehealth coverage and payment for mid-level mental health services
  • A multi-year extension for the Medicare Diabetes Prevention Program Model

The January 1, 2024 rule outlines a shift of payment by Medicare from specialists to primary care providers.  Multi-specialty groups, academic teaching health systems, and single specialty groups are situated to see financial implications immediately.    Practices across specialties continue to experience growing patient needs, no sign of expense reprieve related to practice costs, and continued compounding of Medicare cuts.

Although some areas of the Final Rule provide program enhancement, practices are left with the delicate balancing act of practice viability and patient access.

The Final Rule is available on the Federal Register website.