ASA Offers Congress Solutions for Fixing the Broken Medicare Payment System

On October 31, 2022, the American Society of Anesthesiologists (ASA) contributed solutions to several House members for fixing the broken Medicare physician payment system and improving the Quality Payment Program. For anesthesiologists, the Medicare physician payment system is especially unsustainable, as current Medicare payment rates for anesthesia services are less than one-third of commercial rates. Without Congressional action, anesthesiologists and their groups may be facing a combined 10% payment cut to their 2023 Medicare payments. Congress must add additional resources to the Medicare payment system to support reasonable payment rates. 

The ASA formal communication   comes in response to a Congressional request for information that sought information on how best to “keep our patients safe and our workforce strong.” ASA fears that continued declines in Medicare patients will have a devastating impact on anesthesiologists’ practices while the country continues to struggle with the COVID-19 pandemic, evolving variants, rising inflation, health care worker burnout, staffing shortages, and regulatory requirements that increase administrative burden on practices. The letter supports patching the proposed 2023 cut to the Anesthesia Conversion Factor, waiving the 4% PAYGO sequester, and providing inflationary support to physician practices. 

The letter also highlights that the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) has not fulfilled its promise to pay for health outcomes or to transform how improved patient quality and care can result in more stable payments to physicians and their groups. Anesthesiologists and their groups have participated in the MACRA Quality Payment Program for nearly five years and the highest performing groups have only received about a 2% bonus for their work. ASA recognizes that there simply is not a financial return on investment for groups to participate in MIPS and oftentimes successful participation in the program can still result in overall negative costs. Significant reforms, including additional resources, are needed.  

ASA recommended that Congress extend the exceptional performance bonus for Merit-based Incentive Payment System (MIPS) participants, reward MIPS participants who exceed the performance threshold but fall short of the exceptional performance bonus, and encourage CMS to provide a better pathway for MIPS participants to join Alternative Payment Models (APMs). ASA likewise supports the continuation of the 5% bonus for APM participation and requested that Congress ensure that APM incentives are equitably divided among members of the patient’s care team.