September 29, 2022

ACR Comments on the 2023 Medicare Physician Fee Schedule Proposed Rule

The American College of Radiology® (ACR®) submitted comments to the Centers for Medicare and Medicaid Services (CMS) Sept. 2, that address numerous issues and make specific recommendations related to the 2023 Medicare Physician Fee Schedule (MPFS) Proposed Rule.

In calendar year 2022, CMS began the first year of transitioning in the clinical labor pricing update, which had not been updated since 2002. 2023 will mark the second year of the phase-in, which is expected to finish in 2025. Data from the Bureau of Labor Statistics (BLS) was the primary source of clinical labor pricing information, but CMS also cross-walked or extrapolated wages from other sources such as Salary Expert. In its comment letter, the ACR reiterated continued concern about the timing of the update, following the COVID-19 pandemic. While we understand that the pricing for clinical staff had not been updated for 20 years, specialties with higher supplies and equipment costs will be experiencing additional cuts as a result of the budget neutrality adjustments to compensate for the increases in clinical labor pricing. The College also commented that it would support regular updates to the practice expense components (supplies, equipment, clinical labor staff) to avoid large redistributive effects to specialties in the future.

CMS solicited for comments from stakeholders on how it might improve the collection of practice expense (PE) data inputs and refine the PE methodology. They acknowledge that while they have made some strides toward updating the supplies, equipment, and clinical labor pricing, some of the indirect PE inputs are over a decade old and would benefit from routine updates to avoid unpredictable shifts in payment. The ACR urged CMS to not make any changes to the indirect PE methodology or calculations until after the American Medical Association collects and shares the data from their practice cost survey.

In addition to these topics, the ACR commented on malpractice relative value unit changes, valuation of specific codes, colorectal cancer screening coverage, rebasing and revising the Medicare Economic Index (MEI), payment for Medicare telehealth services and the Quality Payment Program.

CMS estimates an overall impact of the MPFS proposed changes to radiology to be a 3% decrease, a 4% decrease for interventional radiology, a 3% decrease for nuclear medicine, and a 1% decrease for radiation oncology and radiation therapy centers if the provisions within the proposed rule are finalized. However, the cuts could be much larger without congressional action. The one-year 3% conversion factor increase provided by the Protecting Medicare and American Farmers from Sequester Cuts Act will expire at the end of 2022, and there are statutory-mandated pay-as-you-go cuts that also require congressional action. These reductions combined could amount to double-digit decreases for imaging services.

CMS will take into consideration comments received from all stakeholders to the proposed rule and will release its final rule in early November.

For questions about the 2023 MPFS proposed rule and ACR comments, please contact Katie Keysor, Senior Director for ACR Economics and Health Policy.