MGMA Senior Vice President for Government Affairs, Anders Gilberg, discusses some of what’s the organization is anticipated in the 2024 Physician Fee Schedule.
As the health care world awaits the release of the 2024 Physician Fee Schedule, it seems that Congress is more dysfunctional than ever, leaving many to feel confused and uncertain.
It was in this atmosphere of uncertainty that Anders Gilberg, senior vice president of government affairs for MGMA, sat down for an exclusive discussion of what the organization has its eyes on in Washington D.C. with Physicians Practice on Oct. 24, during the 2023 Leaders Conference.
The following transcript has been edited for clarity and length.
You can find the rest of our MGMA Leaders Conference 2023 coverage here.
Physicians Practice: What’s at the top of mind for the MGMA Washington crew right now?
Anders Gilberg: So, one of the main things we're looking at is the policies that will be implemented on January 1 from the 2024 Physician Fee Schedule. Obviously, there's a quick bit of dysfunction on the Hill right now. So, we're not a partisan organization, but we're certainly impacted by the ability of Congress to do its job and to effectively move legislation.
One of the principal things that's happened this week that I'm very, very excited about is the doctors caucus, which are members of Congress that are physicians, put out a discussion draft to address some of the problems we're seeing on physician reimbursement in the Medicare program.
So, the confluence of this is that the 2024 Physician Fee Schedule, which will be published next week. We expect there to be a reduction in the conversion factor, which is basically overall reduction in payment to physicians, at about 3.4%. We'll see the final number next week. And that needs to be addressed.
P2: And why are we expecting those cuts?
AG: Anytime you raise or decrease the amount of money that would be spent in Medicare by $20 million or more by adjusting RVUs as part of the equation, the relative value unit, then you have to offset it with a budget neutrality adjustment. And the budget neutrality adjustment is what makes up the majority of the reduction in the conversion factor. So, another way of saying it is, you're adding over on one side of the equation, and then you must take away from the other, but that is often spread an inequitable manner among specialties.
One of the triggers for that, though, is the implementation of a new code. It's a little wonky, but it's the only time you'll hear me talk about a code, which is G2211, it has a longer name, but it's largely a code that CMS wants physicians to put on claims, if they have more complex visits.
There's a split in medicine about the use of this code. We're kind of concerned about the code because in talking to members, including primary care members at this conference, it's administratively complex and problematic sometimes to implement a code in cases where a physician could have just coded a higher-level visit, also things like work RVUs and other RVUs are used to determine different types of productivity compensation plans. And so, when CMS comes up with an alternative way of implementing things, anytime there's a non-standardized way of approaching something, that's the bane of our existence as healthcare administrators.
I think I'd be remiss to not say that primary care physicians are often largely underpaid relative to specialists. And so, we want to continue to incentivize preventive care and all the important things they do so stay tuned.