July 12, 2024
ACEP Action Alert
Urge Congress to Stop the Medicare Cuts

Once again, physicians and other providers will face yet another cut to Medicare reimbursements, further destabilizing our already fragile health care safety net. 

(See the Regulatory Report below for detailed information on the recently released CMS Physician Fee Schedule Proposed Rule which outlines the Medicare annual payment rule for 2025.)

If this 2.8% cut is implemented on January 1, 2025, it will mark the fifth consecutive year of reductions in Medicare physician payments – continuing an untenable course when your emergency departments across the country are already struggling under the severe strain of the boarding crisis.

For decades, Medicare physician reimbursements have failed to keep up with inflation, despite other Medicare participants receiving annual inflationary updates. Rather than face a yearly scramble to address steep payment cuts, we need your help to urge Congress to work with us and other stakeholders to swiftly identify policy solutions that will provide long-term stability for Medicare beneficiaries and the physicians who manage and provide their health care.

Click here to take action!

Although many physician specialties and health care providers will be impacted by the cut, it is critical that you reach out to your legislators to identify the specific threats to the health care safety net that would result and the circumstances that exist because of the EMTALA mandate.

Ask your U.S. Representative and Senators to urgently work together with the physician and provider community to stop the cuts before the end of the year, and to develop and implement sustainable, long-term solutions that will stabilize the Medicare payment system, prevent the annual threat of significant reimbursement cuts, and preserve access to the health care safety net that our patients need and deserve.

Regulatory Report
CMS Releases Physician Fee Schedule Proposed Rule

On July 10, the Centers for Medicare & Medicaid Services (CMS) released a Medicare annual payment rule for calendar year (CY) 2025 that impacts payments for physicians and other health care practitioners. The rule combines proposed policies for the Medicare physician fee schedule (PFS) with those for the Quality Performance Program (QPP)—the quality performance program established by the Medicare Access and CHIP Reauthorization Act (MACRA).

Notable highlights include:
• Conversion Factor: In 2024, Congress provided a total of 2.93% in relief through the Consolidated Appropriations Act of 2023 (CAA, 2023) and the CAA, 2024. In addition, CMS made other adjustments to code values and added new codes. All these modifications lead to a .05 percent positive budget neutrality adjustment. 

The proposed CY 2025 PFS conversion factor reflects the statutory 2.93% cut and the 0.05 percent budget neutrality adjustment — and is $32.3562, a decrease of $0.93 or -2.8% percent from the CY 2024 PFS conversion factor of $33.2875. Emergency medicine reimbursement in 2025 would remain flat, not including the 2.9 percent Congressional fix.

• Urgent and Acute Care Request for Information (RFI): CMS is soliciting feedback about capacity and workforce issues in relation to acute care and is seeking comment on when it may be appropriate to receive care in an urgent care clinic rather than an ED. 

• ACEP developed an emergency medicine-focused MVP that became available in 2024. In this year’s rule, CMS is proposing to add 1 quality measure and remove 2 quality measures  from the Emergency Medicine MVP. 

• In this year's rule, CMS issues a RFI seeking comments on clinician readiness to transition to MVPs with the additional sunset of traditional MIPS (which has a target sunset data of 2029), considerations on the availability and applicability of MVPs for all clinicians and establishing subgroup composition criteria. Though the target sunset date for traditional MIPS is 2029, CMS is NOT proposing it at this time.

Find a full summary and ACEP’s first takes of the proposed rule here.

CMS Releases Outpatient Prospective Payment System (OPPS) Proposed Rule

On July 10, CMS released the CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1809-P), which includes proposals related to Medicare hospital outpatient and ambulatory surgical center payment, among other issues.  

For CY 2025, CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment Systems by a factor of 2.6%. This increase factor is based on a proposed hospital market basket percentage increase of 3.0 percent reduced by a productivity adjustment of 0.4 percentage point. In continuation of an existing policy, hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2% reduction in the CY 2025 fee schedule increase factor. 

Of note, CMS proposes a new hospital Condition of Participation (CoP) for obstetric services, which includes a revision to the emergency services COP that hospitals must follow.  

ACEP intends to comment by the due date of September 9th, 2024.

State Legislative Updates

Historic Increase in Medi-Cal Reimbursement Signed by Governor Newsom

Beginning January 1, 2025, Medi-Cal reimbursement for E&M codes will increase to 90% of Medicare and reimbursement for procedures will increase to 80% of Medicare. Reimbursement for emergency physicians treating Medi-Cal patients is currently at approximately 54% of Medicare. Thanks to ACEP members for sending over 9,800 messages to CA state legislators sharing their personal stories about how Medi-Cal underfunding and lack of access to care impacts their constituents.

New Hampshire Passes Out-of-Network Law to Follow No Surprises Act

NH SB 173 enacts the same requirements that exist under the federal No Surprises Act (NSA) for payments related to out-of-network services. Unique to NH, upon failure of open negotiation between an insurer and a physician group, both parties have the option to utilize either the state or the federal IDR process.

A summary is available here. 

State Legislation Tracked by ACEP

To share legislative activity happening in your state, contact Adam Krushinskie. Check out the state legislation that is currently identified and being tracked by ACEP:

• Scope of Practice
• Violence Against Health Care Workers
• ED Boarding and Crowding
• Private Payer/Insurance
• All Other Bills

NEMPAC
ACEP Members Advocating through NEMPAC 

ACEP Advocacy Leaders and NEMPAC supporters often have opportunities in their communities to educate legislators and advocate for the concerns of emergency physicians and patients through the National Emergency Medicine Political Action Committee (NEMPAC), sponsored by ACEP. NEMPAC pools voluntary contributions from ACEP members to support candidates for the U.S. Senate and House of Representatives.

Recently, NEMPAC Chair Peter Jacoby attended an event in Waterbury, CT for Rep. Jahana Hayes (D-CT). 

Rep. Jahana Hayes (D-CT) and Dr. Peter Jacoby

ACEP Advocacy Leaders Program

ACEP's Advocacy Leaders Program supports emergency physicians interested in taking their engagement and advocacy with federal legislators and staff to the next level. If you are interested in joining or already have a relationship with a federal legislator, complete this short form to receive more information.

ACEP Votes
Prepare for the November Elections! 

Are you registered to vote at your current address? Have you confirmed your current polling location and voting requirements in your state? ACEP can help: enter your address information for voter resources and to see the list of candidates in your area.