On July 10, the Centers for Medicare and Medicaid Services unveiled a Proposed Rule expressing anticipated modifications to agendas such as expanding telehealth service, enhancing specialized ambulatory care, augmenting health integration services, and the promotion of better healthcare provider training.
The Proposed Rule is designed to update health policies to cater to the evolving technology and changing health needs of the aging population. Ambulatory specialized care is set to be improved by refining existing methods and developing novel treatment pathways.
The up-gradation of caregiver training will empower healthcare practitioners to maintain high standards in the rapidly evolving medical landscape. The merge of behavioral and physical health services is slated to enhance the overall health and vitality of patients.
The growth of telehealth services is expected to expand healthcare access, especially for remote areas or those with mobility issues. The Proposed Rule is expected to reduce the burden on healthcare providers, increase efficiency, generate savings, and positively influence high-need Medicare beneficiaries.
The 2024 budget saw a 3.4% cut in the Medicare conversion factor, leading to concerns of financial strain on patients and providers. Despite the adjustment, the 2024 Medicare conversion factor remained lesser by $0.60 than the 2023 rate. However, consistent discussions and advocacy led to the final decision of $33.29, indicating an ongoing conversation around healthcare funding.
Updating healthcare services through proposed rule
Medicare’s payment structure entails several elements, principally relative value units (RVUs), that account for work, malpractice, and practice expense. The RVUs are critical to Medicare’s system, providing a fair and practical fee allowance for each type of medical service while the Geographic Practice Cost Indices adjust the overall payment to reflect relative local costs.
These mechanisms ensure a balanced, standardized payment system and contribute towards an accurate reimbursement system. The constant adjustments in RVU’s and GPCIs ensure sustainability. They aim to rectify variations between rural and urban providers while reflecting service complexity.
According to Medicare’s 2024 Physician Fee Schedule, reductions for a 99203 service will vary between cities. Both Atlanta and Richmond will experience a decrease in service fees; however, physicians in Atlanta will earn slightly more per service.
CMS believes that adjustments in RVU values, GPCIs, and Conversion factors are necessary to control payment rates due to the strict budget requirements set by the legislation. In spite of criticism, CMS maintains that cost-saving and resource optimization are crucial to comply with the budget neutrality mandate, showcasing significant fiscal constraint.
The decrease of Conversion Factor by about 11%, indicates CMS’s commitment towards cost management. Although these pose challenges to healthcare providers, it is necessary for the stability of the Medicare program.
