00:00:21Introduction to TMA Practice Well Podcast
00:01:49Medicare’s Impact on Physician Income
00:03:51TMA Resources for Texas Physicians
00:04:41Conclusion and Next Steps
SOBRE ESTE EPISÓDIO
Welcome to this episode of the TMA Practice Well podcast, hosted by Cheryl Krhovjak, Director of the TMA Education Center. In this insightful discussion, we are joined by Robert Bennett, TMA Vice President of Medical Economics, to delve into the significant impact of Medicare 2025 physician fee schedule. With over 65 million beneficiaries, Medicare is a key player in health care, and its spending is projected to surge in the coming years.
Robert highlights the recent updates in the 2025 Medicare Physician Fee Schedule, including anticipated reductions in conversion factors unless Congress intervenes. This episode underscores the challenges faced by health care practices due to administrative burdens and payment cuts, which threaten patient access to physicians.
The episode also discusses legislative efforts such as the Medicare Payment Access and Practice Stabilization Act of 2024 and the Strengthening Medicare for Patients and Provider Act, aimed at stabilizing physician payments and ensuring fair inflationary updates. Listeners are encouraged to advocate for these changes to protect their practice and patients.
Additionally, discover the resources offered by the Texas Medical Association, including the Physician Payment Resource Center, to assist Texas physicians in navigating billing, coding, and payment challenges. Tune in for actionable insights and tips to help your practice thrive in the evolving healthcare landscape.
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WEBVTT
00:00:05.557 --> 00:00:10.197
Thank you for listening to TMA's Practice Well podcast. TMA,
00:00:10.437 --> 00:00:13.277
helping you improve the health of all Texans.
00:00:12.560 --> 00:00:21.840
Music.
00:00:21.297 --> 00:00:26.257
Hello, I'm Cheryl Krhovjak. I'm the director of the TMA Education Center,
00:00:26.257 --> 00:00:32.697
and I produce the TMA Practice Well podcast, where through CME2Go and actionable quick tips,
00:00:32.917 --> 00:00:37.997
we strive to provide physicians a reliable resource to help your practice thrive.
00:00:38.357 --> 00:00:43.117
My guest today is Robert Bennett, TMA Vice President of Medical Economics.
00:00:43.677 --> 00:00:49.577
So Robert, why is Medicare such a major factor in physicians' patient panels?
00:00:49.577 --> 00:00:55.417
But we need to understand that Medicare is one of the dominating factors and
00:00:55.417 --> 00:00:59.277
players in this area, with over 65 million beneficiaries and growing.
00:00:59.717 --> 00:01:07.437
They've spent over $873 billion in 2022, so that's well over a billion dollars a day.
00:01:07.777 --> 00:01:11.977
Medicare enrollment's surging, baby boomers are reaching that age,
00:01:12.037 --> 00:01:17.337
and we expect spending will double over the next 10 years and reach up to $1.9 trillion.
00:01:18.097 --> 00:01:22.477
So in 2021, according to the latest data, Medicare spending per beneficiary
00:01:22.477 --> 00:01:25.477
was about $15,000, and we know that varies widely.
00:01:26.057 --> 00:01:30.997
We also know that Medicare beneficiaries are showing interest in the Medicare Advantage plans.
00:01:31.237 --> 00:01:35.597
We have just over half of these beneficiaries are enrolled in such plans,
00:01:35.677 --> 00:01:40.917
and that's continuing to grow with estimates of it reaching 22% or more compared
00:01:40.917 --> 00:01:43.157
to traditional Medicare in future years.
00:01:44.037 --> 00:01:49.417
Robert, I think we all know that every year, Medicare changes the physician fee schedule.
00:01:49.497 --> 00:01:56.657
So what are we looking at for 2025 and what can physicians do to protect their income?
00:01:57.500 --> 00:02:03.340
On November 1st, 2024, CMS issued the 2025 final Medicare Physician Fee Schedule.
00:02:03.520 --> 00:02:08.680
In it, it confirmed what we expected, that Medicare, unless Congress intervenes,
00:02:08.780 --> 00:02:12.080
will reduce the conversion factor by 2.93%.
00:02:12.080 --> 00:02:19.380
Similarly, the anesthesia conversion factor is also reduced by roughly 3% to $20.32.
00:02:19.820 --> 00:02:25.220
TMA's response to CMS and Congress on Medicare payment cuts remains that we
00:02:25.220 --> 00:02:28.220
are concerned practices continue to operate on thin margins,
00:02:28.400 --> 00:02:30.780
especially compared to the larger integrated systems.
00:02:31.060 --> 00:02:34.820
We also point out that the healthcare marketplace is increasingly hostile to
00:02:34.820 --> 00:02:38.440
practices with things like prior authorizations, delayed enrollment,
00:02:38.940 --> 00:02:42.320
other administrative burdens, and now a decrease in payment.
00:02:42.800 --> 00:02:48.460
Thus, we point out that these factors could result in decreased patient access to physicians.
00:02:48.820 --> 00:02:52.920
So we are calling on physicians and we're calling on their patients to urge
00:02:52.920 --> 00:02:57.520
Congress to pass the Medicare Payment Access and Practice Stabilization Act of 2024.
00:02:57.920 --> 00:03:05.120
It was introduced in late October. It averts the 2025 cut entirely and provides
00:03:05.120 --> 00:03:10.300
a 12-month modest increase, which is half of the Medicare Economic Index, or MEI,
00:03:10.780 --> 00:03:15.220
which aligns with the Medicare Payment Advisory Commission or MedPAC recommendation.
00:03:16.340 --> 00:03:21.580
Congress will end its current session on January 3rd, 2025.
00:03:21.680 --> 00:03:25.360
So some action could occur before that time.
00:03:25.540 --> 00:03:30.280
We know that one year extension and half of MEI does not get us out of this
00:03:30.280 --> 00:03:34.220
annual cycle of returning to Congress and asking them to prevent cuts.
00:03:34.260 --> 00:03:38.600
So we are also asking Congress to pass the Strengthening Medicare for Patients
00:03:38.600 --> 00:03:40.840
and Provider Act, HR 2474,
00:03:41.260 --> 00:03:46.460
that would permanently address the Medicare physician payment formula by ensuring
00:03:46.460 --> 00:03:50.240
permanent inflationary updates like all other Medicare providers receive.
00:03:51.163 --> 00:03:57.423
Thanks, Robert. One last question. What resources has TMA provided to help Texas physicians?
00:03:57.803 --> 00:04:02.203
We have the Texas Medical Association Physician Payment Resource Center.
00:04:02.483 --> 00:04:06.003
The URL is texmed.org slash payment resource center.
00:04:06.243 --> 00:04:12.583
And at that website, you can find our billing and coding hotline, 512-370-1414.
00:04:12.583 --> 00:04:16.543
It has links to several educational resources,
00:04:17.123 --> 00:04:22.163
things about coding modifiers, how to appeal, information about Texas and federal
00:04:22.163 --> 00:04:26.463
prompt pay information, information on non-covered services,
00:04:27.003 --> 00:04:29.383
social drivers of health or non-medical drivers.
00:04:29.563 --> 00:04:34.963
We discuss when we meet with public and private payers on this resource center.
00:04:35.143 --> 00:04:39.243
And so it's a good place when you have individual coding or claims issues to
00:04:39.243 --> 00:04:40.983
get some help from our team here.
00:04:41.923 --> 00:04:47.503
Great. Thank you, Robert. And to our listeners, thank you for tuning in for this quick tip episode.
00:04:47.823 --> 00:04:51.963
Check out the episode description to get the links mentioned and for the link
00:04:51.963 --> 00:04:55.143
to the complete Medicare 2025 payment update webinar.
00:04:55.483 --> 00:04:57.963
We hope you found this episode beneficial.
00:04:58.463 --> 00:05:03.383
To receive more helpful tips, like and follow TMA Practice Well podcast.
00:05:03.943 --> 00:05:09.883
Until next time, stay well. TMA has a long, proud history of promoting patient
00:05:09.883 --> 00:05:14.163
rights, advocating for physicians, and providing real solutions for your practice.
00:05:14.523 --> 00:05:17.983
We can accomplish so much when we unite in one voice.
00:05:18.263 --> 00:05:25.183
Call the TMA Knowledge Center at 1-800-880-7955 or visit www.texmed.org to find
00:05:25.183 --> 00:05:27.763
out how you can join or renew your membership today.
00:05:28.400 --> 00:05:46.289
Music.
00:00:05.557 --> 00:00:10.197
Thank you for listening to TMA's Practice Well podcast. TMA,
00:00:10.437 --> 00:00:13.277
helping you improve the health of all Texans.
00:00:12.560 --> 00:00:21.840
Music.
00:00:21.297 --> 00:00:26.257
Hello, I'm Cheryl Krhovjak. I'm the director of the TMA Education Center,
00:00:26.257 --> 00:00:32.697
and I produce the TMA Practice Well podcast, where through CME2Go and actionable quick tips,
00:00:32.917 --> 00:00:37.997
we strive to provide physicians a reliable resource to help your practice thrive.
00:00:38.357 --> 00:00:43.117
My guest today is Robert Bennett, TMA Vice President of Medical Economics.
00:00:43.677 --> 00:00:49.577
So Robert, why is Medicare such a major factor in physicians' patient panels?
00:00:49.577 --> 00:00:55.417
But we need to understand that Medicare is one of the dominating factors and
00:00:55.417 --> 00:00:59.277
players in this area, with over 65 million beneficiaries and growing.
00:00:59.717 --> 00:01:07.437
They've spent over $873 billion in 2022, so that's well over a billion dollars a day.
00:01:07.777 --> 00:01:11.977
Medicare enrollment's surging, baby boomers are reaching that age,
00:01:12.037 --> 00:01:17.337
and we expect spending will double over the next 10 years and reach up to $1.9 trillion.
00:01:18.097 --> 00:01:22.477
So in 2021, according to the latest data, Medicare spending per beneficiary
00:01:22.477 --> 00:01:25.477
was about $15,000, and we know that varies widely.
00:01:26.057 --> 00:01:30.997
We also know that Medicare beneficiaries are showing interest in the Medicare Advantage plans.
00:01:31.237 --> 00:01:35.597
We have just over half of these beneficiaries are enrolled in such plans,
00:01:35.677 --> 00:01:40.917
and that's continuing to grow with estimates of it reaching 22% or more compared
00:01:40.917 --> 00:01:43.157
to traditional Medicare in future years.
00:01:44.037 --> 00:01:49.417
Robert, I think we all know that every year, Medicare changes the physician fee schedule.
00:01:49.497 --> 00:01:56.657
So what are we looking at for 2025 and what can physicians do to protect their income?
00:01:57.500 --> 00:02:03.340
On November 1st, 2024, CMS issued the 2025 final Medicare Physician Fee Schedule.
00:02:03.520 --> 00:02:08.680
In it, it confirmed what we expected, that Medicare, unless Congress intervenes,
00:02:08.780 --> 00:02:12.080
will reduce the conversion factor by 2.93%.
00:02:12.080 --> 00:02:19.380
Similarly, the anesthesia conversion factor is also reduced by roughly 3% to $20.32.
00:02:19.820 --> 00:02:25.220
TMA's response to CMS and Congress on Medicare payment cuts remains that we
00:02:25.220 --> 00:02:28.220
are concerned practices continue to operate on thin margins,
00:02:28.400 --> 00:02:30.780
especially compared to the larger integrated systems.
00:02:31.060 --> 00:02:34.820
We also point out that the healthcare marketplace is increasingly hostile to
00:02:34.820 --> 00:02:38.440
practices with things like prior authorizations, delayed enrollment,
00:02:38.940 --> 00:02:42.320
other administrative burdens, and now a decrease in payment.
00:02:42.800 --> 00:02:48.460
Thus, we point out that these factors could result in decreased patient access to physicians.
00:02:48.820 --> 00:02:52.920
So we are calling on physicians and we're calling on their patients to urge
00:02:52.920 --> 00:02:57.520
Congress to pass the Medicare Payment Access and Practice Stabilization Act of 2024.
00:02:57.920 --> 00:03:05.120
It was introduced in late October. It averts the 2025 cut entirely and provides
00:03:05.120 --> 00:03:10.300
a 12-month modest increase, which is half of the Medicare Economic Index, or MEI,
00:03:10.780 --> 00:03:15.220
which aligns with the Medicare Payment Advisory Commission or MedPAC recommendation.
00:03:16.340 --> 00:03:21.580
Congress will end its current session on January 3rd, 2025.
00:03:21.680 --> 00:03:25.360
So some action could occur before that time.
00:03:25.540 --> 00:03:30.280
We know that one year extension and half of MEI does not get us out of this
00:03:30.280 --> 00:03:34.220
annual cycle of returning to Congress and asking them to prevent cuts.
00:03:34.260 --> 00:03:38.600
So we are also asking Congress to pass the Strengthening Medicare for Patients
00:03:38.600 --> 00:03:40.840
and Provider Act, HR 2474,
00:03:41.260 --> 00:03:46.460
that would permanently address the Medicare physician payment formula by ensuring
00:03:46.460 --> 00:03:50.240
permanent inflationary updates like all other Medicare providers receive.
00:03:51.163 --> 00:03:57.423
Thanks, Robert. One last question. What resources has TMA provided to help Texas physicians?
00:03:57.803 --> 00:04:02.203
We have the Texas Medical Association Physician Payment Resource Center.
00:04:02.483 --> 00:04:06.003
The URL is texmed.org slash payment resource center.
00:04:06.243 --> 00:04:12.583
And at that website, you can find our billing and coding hotline, 512-370-1414.
00:04:12.583 --> 00:04:16.543
It has links to several educational resources,
00:04:17.123 --> 00:04:22.163
things about coding modifiers, how to appeal, information about Texas and federal
00:04:22.163 --> 00:04:26.463
prompt pay information, information on non-covered services,
00:04:27.003 --> 00:04:29.383
social drivers of health or non-medical drivers.
00:04:29.563 --> 00:04:34.963
We discuss when we meet with public and private payers on this resource center.
00:04:35.143 --> 00:04:39.243
And so it's a good place when you have individual coding or claims issues to
00:04:39.243 --> 00:04:40.983
get some help from our team here.
00:04:41.923 --> 00:04:47.503
Great. Thank you, Robert. And to our listeners, thank you for tuning in for this quick tip episode.
00:04:47.823 --> 00:04:51.963
Check out the episode description to get the links mentioned and for the link
00:04:51.963 --> 00:04:55.143
to the complete Medicare 2025 payment update webinar.
00:04:55.483 --> 00:04:57.963
We hope you found this episode beneficial.
00:04:58.463 --> 00:05:03.383
To receive more helpful tips, like and follow TMA Practice Well podcast.
00:05:03.943 --> 00:05:09.883
Until next time, stay well. TMA has a long, proud history of promoting patient
00:05:09.883 --> 00:05:14.163
rights, advocating for physicians, and providing real solutions for your practice.
00:05:14.523 --> 00:05:17.983
We can accomplish so much when we unite in one voice.
00:05:18.263 --> 00:05:25.183
Call the TMA Knowledge Center at 1-800-880-7955 or visit www.texmed.org to find
00:05:25.183 --> 00:05:27.763
out how you can join or renew your membership today.
00:05:28.400 --> 00:05:46.289
Music.
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