2022 Healthcare Highlights: Medicare Physician Fee Schedule and Reimbursement Pressures

November 12, 2021

On November 10, 2021, Zotec hosted a new Zotec Shares webinar: 2022 Healthcare Highlights: Medicare Physician Fee Schedule and Reimbursement Pressures.

Mark Isenberg, Zotec’s EVP of Healthcare Advocacy, and Lonnie Johnson, Zotec’s VP of Corporate Services, share their expertise during the webinar and give comprehensive insights into the Medicare Fee Schedule, related advocacy, and upcoming payment changes.

Medicare Fee Schedule Payment Update:

The 2022 Medicare Physician Fee Schedule (MPFS) payment update includes a decrease in the Medicare Fee Schedule Conversion Factor, taking it from $34.89 to $33.59 – a 3.71% decrease. CMS has implemented RVU adjustments on several technical proposals involving practice expenses to clinical labor pricing and rates through a four-year transition period.

Additionally, there are three significant looming reductions to Medicare in 2022: a -2% cut from Sequestration, -4% cut from Pay-As-You-Go across the board in all specialties, and a -3.75% cut in Medicare Physician Fee Schedule. This brings a total of -8.75% in cuts across all of Medicare, and there will also be a continuation of reductions on non-emergent procedures. Subsequently, in 2022, we will see a significant impact on access to care.

Advocacy Efforts:

To help ensure the maintenance of quality healthcare and reliable access to it, Zotec has started a campaign to advocate against these changes and let the government know that these cuts will have an unfortunate, significant impact. To help us make a change, visit Zotecpac.com and text ZPNOW to 52886.

Medicare Fee Schedule Policy Updates:

For 2022 MIPS Policy Updates, Small Practice category weights will change and emphasize the Improvement Activities performance category. This includes reweighting both Cost and Promoting Interoperability. CMS will also use Facility-Based Scoring, in which they will calculate two final scores for clinicians and groups who are facility-based. One score will be for the clinical or group’s traditional MIPS performance, and the other on the application of facility-based measurement.

Quality Payment Program – Traditional MIPS:

For 2022, CMS is extending the COVDI-19 hardship exemption policy. CMS will also continue to double the Complex Patient Bonus (CPB) and refine the method for defining higher-risk patients to allot the CPB. The small practice category weights will change in 2022 to emphasize the Improvement Activities performance category.

There were also changes in the performance thresholds. CMS will be required to establish a penalty threshold at either the historical mean or median of the final MIPS scores for eligible clinicians. CMS finalized changes to the Quality Measuring Scoring regarding data completeness, established new scoring measures, quality measure benchmarks and outcomes, and high priority bonus points.

Beginning in 2022, the MIPS Quality and Cost performance category scores will be based on the facility-based measurement scoring methodology unless a clinician or group receives a higher MIPS final score through another MIPS submission.

Future of Quality Payment Program:

MIPS Value Pathways (MVPs) allows clinicians to report a uniform set of measures on a particular episode or condition. The final rule clarifies the framework of the program’s implementation timelines, participation and registration, and reporting requirements, which begin with the 2023 performance year. CMS finalized seven MVPs and recognizes the need for more under the MIPS value pathway pillars, including quality measures, improvement activities, cost, promoting interoperability, and population health.

Helpful Resources:

On-Demand: To hear the full conversation, view the November Zotec Shares webinar here.
Advocacy: Stay up to date on policy matters and take action now by texting ZPNOW to 52886.
2022 MPFS Final Rule: Read the entire final ruling here.
2022 MPFS Fact Sheet: Review the final ruling snapshot on cms.gov.
2022 QPP Final Rule Resources: Download the fact sheet, policies comparison table, MVP policies table, and FAQ document here.

For questions, please reach out to your Client Relationship or Practice Manager or email advocacyupdates@zotecpartners.com.