November 22, 2022
On November 1, CMS released the 2023 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective payment (OPPS) Final Rules. As expected, the conversion factor for 2023 is lower than the 2022 conversion factor, decreasing by $1.55 from $34.61 in 2022 to $33.06 in 2023. The 4.5% reduction is the result of a combination of factors: the expiration of a 3% supplemental increase to PFS payments for CY 2022 and statutorily required budget neutrality adjustments. The 2023 OPPS Rule provides an increase rate of 3.8%—from the 2.7% included in the proposed rate.
For the MPFS, the SNNMI and other physician organizations have been advocating for Congress and the Administration to offset this reduction. CMS estimates that the final rule will reduce payments to nuclear medicine physicians overall by 1%, but the impact varies depending on the site of service in which the physician practices. CMS estimates that nuclear medicine physicians practicing in a non-facility setting will see a slightly greater reduction (-2%) and nuclear medicine physicians practicing in a facility setting will see a slight increase in estimated payments (+1%). Most nuclear medicine physicians practice in the non-facility setting (94%).
In December 2021, Congress enacted H.R. 1667/S.610, the Protecting Medicare and American Farmers from Sequesters Cuts Act, which staved off the majority of Medicare cuts scheduled to go into effect in 2022. That legislation included a 3% payment increase for physicians, mitigating the impact of the 2022 MPFS final rule, which eliminated the 3.75% increase awarded under the Consolidated Appropriations Act. H.R. 1667/S.610 also delayed the 2% Medicare sequestration set to go into effect as well as Medicare cuts of up to 4% resulting from increasing the federal budget under the American Rescue Plan, which passed in 2021 and triggered mandatory cuts under the Pay-As-You-Go Act of 2010.
SNMMI continues to urge Congress to pass H.R. 8800, the Supporting Medicare Providers Act of 2022, to offset some of these scheduled cuts by extending the 3% payment increase provided in H.R. 1667/S.610. SNMMI joined with several organizations in sending a letter to House and Senate Leadership urging passage before the end of the year. SNMMI will continue to work with coalition members to avert these cuts.
Under the 2023 Hospital OPPS Rule, CMS expects the payment adjustment—in addition to other changes in the rule—to increase OPPS payments by a total of 4.5% as compared to CY 2022 data, and total payments for hospitals (including beneficiary cost sharing) by approximately $3.0 billion in CY 2023 as compared to CY 2022 data. Notably, CMS is relying on cost report data from June 2020 and CY 2021 Claims Report Data in setting 2023 OPPS and ASC payment rates due to concerns of skewed data resulting from the public health emergency. This is the same data used to set rates for 2022.
The CY 2010 payment methodology will continue using the Average Sales Price (ASP) +6% with Medicare covering separately payable therapeutic radiopharmaceuticals drugs and biologicals. If the ASP information is unavailable, the rate will be based on mean unit cost data derived from hospital claims. The ASP+6% payment will also be applied to non–pass through therapeutic radiopharmaceuticals. The CY 2023 bundled package rate is $135/per day.
SNMMI continues to advocate for an unbundling of payments and urges Congress to pass the FIND Act. Under the Medicare Modernization Act (MMA) of 2003, radiopharmaceuticals were classified as stand-alone “drugs” and paid separately from the nuclear medicine procedure; however, in 2008, CMS interpreted the MMA as expired and began bundling payments into Ambulatory Classifications. However, the bundled payment fails to adequately cover the costs for both the procedure and diagnostic radiopharmaceutical, impeding patients' access to care. Additionally, CMS will continue to provide enhanced payments using cost report data to cancer hospitals under OPPS for covered outpatient hospital services to reflect their higher outpatient costs and equal the payment-to-cost ratio at other OPPS hospitals.
The full letter can be viewed here.
The Final CMS 2023 MPFS Rule can be viewed here.
The Final Hospital OPPS Rule can be viewed here.