Health Affairs Launches Series on the Medicare Fee Schedule

If you are looking for a little extra credit reading before the proposed rule is released, check out: Modernizing the Medicare Physician Fee Schedule, Part 1: The Role of a Technical Expert Panel. Health Affairs has released the first of three articles examining policy issues related to the fee schedule. This first article, authored by the always provocative Robert A. Berenson, discusses the role a technical expert panel (TEP) could play in modernizing the fee schedule.

Creation of a TEP for the Fee Schedule

The author advocates for the role of a TEP to support Medicare staff in maintaining the fee schedule. While Dr. Berenson has been critical of the RUC in the past, in this article, he proposes that the TEP would not replace the RUC, but rather address larger policy issues. The article states:

Among a range of potential activities, the TEP would advise on R&D priorities; consider innovative new approaches to determining relative resources per code, such as those identified above; identify and study opportunities for bundling or unbundling services for payment purposes; explore how artificial intelligence should be incorporated into fee schedule payments; and assess the operational burden related to documentation on clinicians and beneficiaries while also considering the vulnerabilities of new approaches to “gaming” and overt fraud and abuse.

Reducing the Number of CPT Codes

The author also proposes reform policies, as detailed in a comment letter on the 2023 proposed rule, which he submitted in collaboration with a group of retired CMS and Medicare Payment Advisory Committee (MedPAC) career staff. Interestingly, one of the recommendations was to reduce the number of codes from the current approximate 9,000 to 500-1000. He argues that this would “thereby reducing the false precision, complexity, and lack of transparency that comes with the requirement to price each minor code variation separately.”

Please let me know if you have any questions or would like to discuss further.

I continue to monitor the release of the fee schedule. Since the reconciliation bill included a 2.5% update, the section on the conversion factor and any related material in the regulations would need to be updated. This might be at least partially what is delaying its release.

 For more information or to discuss, please contact:

Sheila Madhani, MA, MPH

Madhani Healthcare Consulting

smadhani@madhani-health.com/202-679-2977