In this comment letter on the notice of proposed rulemaking for the calendar year 2023 Medicare Physician Fee Schedule (MPFS), a group of national experts—many who had direct responsibility for the MPFS—offer insights into and suggestions for ways to improve Medicare physician payment. The comment was submitted to the Centers for Medicare & Medicaid Services (CMS) and includes principles to guide reform efforts, reform proposals to ensure the future sustainability of the MPFS, and comments on specific topics requested by CMS on sections of the proposed rule.

Why It Matters

This year is the 30th anniversary of CMS’s initial implementation of the MPFS. With 30-year hindsight, it is now time to thoroughly review and significantly revamp the data, algorithms, and processes that CMS uses to establish MPFS payment amounts. The MPFS now has widespread influence on the US health care system. Further, payment reform for physicians and other health professionals through Medicare must be part of the effort to build a more equitable health system that results in better accessibility, quality, affordability, and innovation and will succeed only with a modernized fee schedule. In addition, many value-based payment initiatives are built on the foundation of the MPFS.

Key Takeaways

• The processes and data sources used by CMS to set and update payments in the MPFS lead to distorted fees. We offer concrete suggestions for modernizing the process and improving accuracy, including establishing an expert advisory panel within CMS.
• CMS needs a new approach to identify and update misvalued services in the MPFS that includes a better method to establish work relative value units (RVUs).
• Inaccurate estimates of time lead to inaccurate allocation of indirect practice expense RVUs; the ideal solution would be to base both work and practice expense on accurate time data.
• We strongly urge CMS to consider eliminating the 10-day global period and adjusting payments accordingly and to reconsider payments for 90-day global periods to accurately reflect the delivery of services during that period.
• Telehealth services are an increasingly important element of care delivery and care CMS should consider adopting alternative payment methods for telehealth consistent with its statutory authority.