Proposed Reduced Conversion Factor Would Cut Vascular Surgeon Reimbursements

Jul 20, 2023

The Centers for Medicare & Medicaid Services (CMS) in mid-July released two payment-related proposed rules—the highly-anticipated Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule (MPFS) and the Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (OPPS). The Society for Vascular Surgery will submit comments for both proposed rules by the Sept. 11 due date.

For CY 2024, CMS has proposed a conversion factor—a critical component for calculating Medicare payments—of $32.75, a decrease of approximately 3.4% from the CY 2023 conversion factor. Preliminary SVS analysis, in addition to the impact charts provided in the proposed rule by CMS, indicate that vascular surgeons, depending on practice setting, face a 3% to 4% cut based on current Medicare policies proposed in the MPFS rule.

These cuts result from a reduction in the temporary update to the conversion factor under current law and a negative budget neutrality adjustment stemming in large part from CMS moving forward with implementation of separate payment for add-on code G2211 to account for visit complexity associated with certain office/outpatient evaluation and management care. G2211 was initially proposed three years ago, but implementation was delayed as a result of an aggressive advocacy campaign led by the surgical societies, including the SVS. In addition, payment reductions for many vascular surgeons are compounded by the third year of CMS’ phased-in implementation of its clinical labor pricing update, which was finalized in the CY2022 MPFS Final Rule.

CMS is proposing an update to OPPS for hospitals that meet the quality reporting requirements by 2.8%. The update is based on the projected inpatient hospital market basket percentage increase of 3.0% reduced by a 0.2 percentage point for productivity adjustment.

The SVS is aware of the significance of the policies outlined in these rules—particularly the additional Medicare payment reductions vascular surgeons face and the potential impacts on patient care and access. There is broad agreement that the Medicare physician payment system is broken and that physicians/surgeons are reeling due to yearly budget neutrality adjustments and the fact that the MPFS is the only fee schedule lacking an annual inflationary update.

The SVS, in collaboration with medical specialty societies, is continuing to work to mitigate the scheduled cuts and advance policies to stabilize the payment system in the short term and reform the system in the long term. To that end, the SVS supports legislation to provide an inflationary update for the MPFS (H.R. 2474, see below) and is leading the effort that brought forth the introduction of legislation to provide targeted relief for codes most impactedby the clinical labor update policy (H.R. 3674, see below). The SVS will also seek further delay of the G2211 code implementation via the comment period on the rule and legislative relief with an additional delay.

Visit the SVS Advocacy Center to urge your lawmakers to support these important bills.

The SVS is analyzing both rules and will submit extensive comments to CMS. In addition, SVS will continue to collaborate with other surgical and medical specialty societies to amplify our message on Capitol Hill for Congress to address these cuts before the end of the year. SVS is also working in earnest to identify long-term solutions that will provide stability and equity across the Medicare physician payment system. SVS members should be prepared to engage in these ongoing advocacy efforts through the remainder of the year.

Related Articles