MGMA Appeals to Congress to Address MD Reimbursement Issues
The leaders of the Englewood, Colo.-based MGMA (Medical Group Management Association) are appealing to the senior leaders of both parties in Congress to consider—and act on—the reimbursement challenges that medical groups are facing in the current moment. On Nov. 12, MGMA sent a letter under the signature of Anders Gilberg, the association’s senior vice president, government affairs, to the four senior leaders in Congress: Rep. Mike Johnson (R.-La), Speaker of the House of Representatives; Sen. Charles (Chuck) Schumer (D.-N.Y.), Senator Majority Leader; Rep. Hakeem Jeffries (D.-N.Y.), House Minority Leader; and Sen. Mitch McConnell (R-Ky.), Senate Minority Leader.
The letter began thus: “Dear Speaker Johnson, Majority Leader Schumer, Minority leader Jeffries, and Minority Leader McConnell: On behalf of our member medical group practices, the Medical Group Management Association (MGMA) thanks you for your leadership in supporting medical group practices’ ability to provide high-quality, cost-effective care. As we approach the end of 2024, we write to emphasize the urgent need for Congress to pass legislation regarding three key issues important to medical groups: averting the finalized cut to Medicare payment and providing an inflationary update for 2025, passing prior authorization reform, and extending telehealth flexibilities. With a membership of more than 60,000 medical practice administrators, executives, and leaders, MGMA represents more than 15,000 medical group practices ranging from small private medical practices to large national health systems, representing more than 350,000 physicians. MGMA’s diverse membership uniquely situates us to offer the following legislative recommendations.”
Meanwhile, the letter went on, “The Centers for Medicare & Medicaid Services (CMS) recently finalized its 2025 Medicare Physician Fee Schedule (PFS) that will cut the Medicare conversion factor by 2.83% beginning Jan. 1, 2025. MGMA asks that Congress quickly pass the Medicare Patient Access and Practice Stabilization Act of 2024 (H.R. 10073) that would stop the full cut to Medicare conversion factor, in addition to providing a positive update equal to half of the Medicare Economic Index (MEI) to Medicare reimbursement for 2025. Without stopping the cut and providing this modest update, medical groups will endure an untenable further reduction to physician reimbursement that will compound other financial pressures such as staffing shortages and rising operational costs. In MGMA’s 2023 regulatory burden survey, 87% of medical group practices said reimbursement not keeping up with inflation would impact current and future Medicare patient access. Practices have detailed having to consider limiting the number of new Medicare patients, reducing charity care, reducing number of clinical staff, and closing satellite locations should Medicare payment continue on this trajectory. As one MGMA member put it, “[b]etween the reimbursement cuts and increasing regulatory costs, keeping the doors open becomes more challenging daily.” According to MGMA data, physician practices saw total operating cost per FTE physician increase by over 63 percent from 2013–2022, while the Medicare conversion factor increased by only 1.7 percent over the same timeframe. Further, 92 percent of medical groups reported an increase in operating costs in 2024.3 In the face of these serious financial tensions, another reduction to Medicare reimbursement is unconscionable — it is imperative to address the cut as quickly as possible.”
In a press release on the same date, MGMA leaders summarized their recommendations thus:
Ø The Centers for Medicare & Medicaid Services (CMS) recently finalized its 2025 Medicare Physician Fee Schedule (PFS) that will cut the Medicare conversion factor by 2.83 percent beginning Jan. 1, 2025. MGMA asks that Congress quickly pass the Medicare Patient Access and Practice Stabilization Act of 2024 (H.R. 10073) that would stop the full cut to Medicare conversion factor and provide a positive update equal to half of the Medicare Economic Index (MEI) to Medicare reimbursement for 2025.
Ø While avoiding this impending cut and providing a positive update to account for inflation in 2025 is of foremost importance, permanent reform to the Medicare payment system is needed to sustainably support medical groups and avoid these yearly threats to their financial viability. MGMA asks that Congress pass the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would provide an annual Medicare physician payment update tied to inflation, as measured by the MEI.
Ø Modernizing changes are needed to the antiquated budget neutrality policies in the Medicare PFS to avoid this continual dance of physician practices staring down yearly cuts to reimbursement. MGMA asks that Congress pass the Provider Reimbursement Stability Act (H.R. 6371) that would make updates such as increasing the triggering threshold from $20 million to $53 million (while adding an update to keep pace with inflation) and instituting new utilization review requirements to better reflect the reality of providers using certain services compared to CMS’ estimates.
Ø Onerous prior authorization requirements continuously rank as the number one regulatory burden facing medical groups. The Improving Seniors’ Timely Access to Care Act (S. 4532) has the support of a bipartisan majority of the House and Senate, nearly 500 endorsing stakeholder organizations, a minimal expected CBO score, and little to no opposition. MGMA urges Congress to ensure this bill is included in any year-end budget package.
Ø MS finalized its extension of certain telehealth policies in its 2025 Medicare PFS, but many of the central policies that have allowed telehealth to flourish will expire soon without congressional action. MGMA urges Congress to act before the end of the year to extend the removal of geographic and originating site restrictions, the expanded list of providers, and more to ensure Medicare beneficiaries can access care no matter where they are located. Not doing so would significantly hinder medical groups’ ability to offer telehealth services nationwide.
The full version of the advocacy letter to the leaders in Congress can be found here.
