CMS cuts physician pay, adds 5 orthopedic codes to ASC payable list

Practice Management

CMS released final rules for the 2024 Physician Fee Schedule and Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Nov. 2, and spine and orthopedic surgeons will see changes next year.

CMS plans to cut overall physician pay 1.25% in 2024 and the conversion factor will be $32.74, a 3.4% drop from this year despite also recognizing the highest medical practice cost inflation since 2000, with a 4.6 percent increase in the Medicare Economic Index.

"CMS' final rule should put to rest how the bureaucracy and leadership view physicians," said Brian Gantwerker, MD, neurosurgeon and owner of The Craniospinal Center of Los Angeles. "The devaluation of healthcare and practice of medicine is proof positive CMS wishes to drive the train over the cliff and drive us into single payer. I think those that welcome the calamity will think otherwise when they have zero say in how their services are valued."

Physician groups have also been critical of the decision.

"This is a recipe for financial instability," Jesse Ehrenfeld, MD, president of the American Medical Association, wrote in a statement. "Patients and physicians will wonder why such thin gruel is being served. Physicians routinely have faced cuts in the last two decades. Yet, there is nothing routine about the past few years. Physicians have faced the COVID pandemic and subsequent burnout. They have seen the costs soar for running a medical practice, while Medicare payment updates have offered too little relief."

The declining pay could put access to care at risk. While most spine surgeons continue to see Medicare patients, sometimes at a loss to the practice, there could be a tipping point in the near future.

"I believe this will accelerate current trends," said Harel Deutsch, MD, co-director of the Rush Spine Center in Chicago. "Physicians in private practice will not be able to sustain a practice treating Medicare patients. There will be decreased access to care for Medicare patients and generally more treatment through nurse practitioners and physician assistants."

In the final rule addressing pay to ASCs, CMS decided to keep aligning the ASC update factor with the hospital outpatient department payments update for the next two years, leading to a 3.1% pay increase for ASCs next year. The agency also added 11 surgical codes to the ASC payable list, including the following codes for orthopedic procedures:

  • 23470 (Reconstruct shoulder joint)
  • 23472 (Reconstruct shoulder joint)
  • 27006 (Incision of hip tendons)
  • 27702 (Reconstruct ankle joint)
  • 29868 (Meniscal transplant knee with knee scope)

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