NAACOS Analysis of the proposed
2024 Medicare Physician Fee Schedule rule
Executive Summary
On July 13, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (MPFS) Proposed Rule. This proposed regulation includes several positive changes to the Medicare Shared Savings Program (MSSP) for which NAACOS has long advocated.
In this analysis, we provide details on key proposals affecting ACOs. The rule is summarized in several fact sheets provided by CMS: MPFS Fact Sheet, MSSP Fact Sheet and Quality Payment Program (QPP) Fact Sheet.
Comments to CMS in response to the proposed rule are due on September 11 and may be submitted on the regulations.gov website. NAACOS is seeking member input on the proposals in this rule, which will help shape our comments. Please share your feedback by emailing us at [email protected]. NAACOS will provide draft comments ahead of the deadline. CMS will review comments and issue a final rule later this year, typically by November 1.
Medicare Physician Payment Proposals
- Decreases the Medicare conversion factor from $33.89 to $32.75 for 2024.
- Implements an evaluation and management visit add-on code for complexity (G2211); this code was previously delayed by Congress. CMS is proposing implementation with modifications.
- Creates new codes for community health integration services and social determinants of health (SDOH) risk assessment.
MSSP Proposals
Assignment Methodology:
- Adds a third step to the assignment process in 2025 that would expand the assignment window for a physician visit to two years; this allows the assignment methodology to better account for beneficiaries who primarily receive services from a nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS).
- Adds several new codes to the definition of primary care services used in ACO assignment.
Benchmarks and Risk Adjustment:
- Proposes to effectively eliminate the negative regional adjustment.*
- Modifies its use of the CMS-Hierarchical Condition Code (HCC) risk adjustment model to account for the new model version starting in 2024 by using the same model version in benchmark and performance years.*
- Phases in new risk model version over three years for all ACOs starting next year.*
- Caps the risk score growth in an ACO’s region for agreements beginning in 2024, making the cap on the ACO and its region symmetrical.*
- Seeks comment on potential further refinements to the Accountable Care Prospective Trend and increasing the prior savings adjustment.*
Quality:
- Creates a new quality reporting option for MSSP ACOs; the Medicare Clinical Quality Measures reporting option would require ACOs to report only on Medicare beneficiaries, providing flexibility with the previous all-payer reporting requirement.*
- Changes the Quality Performance Standard calculations to use historical data.*
- Adjusts policies related to quality scoring requirements for suppressed measures and makes changes to Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures.
- Removes Certified Electronic Health Record Technology (CEHRT) threshold requirements for certain MSSP ACOs.
- Solicits comments on Merit-based Incentive Payment System (MIPS) Value Pathways quality reporting for specialists in MSSP ACOs.
Other:
- Seeks comments on the potential for an Enhanced Plus Track, which would allow higher levels of risk in MSSP.*
- Modifies policies for advance investment payments (AIPs) to allow ACOs receiving AIPs to transition to a two-sided risk model under the Basic Track in Performance Year (PY) Three, to allow an exception to the recoupment policies for ACOs that early renew, to permit reconsideration of quarterly payment calculations, and to update policies related to early termination and reporting.*
- Revises MSSP eligibility requirements and clarifies definitions for experience with performance-based risk.
- Seeks comments on ways to increase collaboration between ACOs and community-based organizations (CBOs).
Quality Payment Program Proposals
- Makes all advanced alternative payment model (APM) qualifying participant (QP) determinations at the individual level only, instead of the APM entity level and modifies the attribution methodology.
- Makes updates to MIPS requirements for APMs.
- Increases the MIPS performance threshold from 75 to 82 points for PY 2024.
*Denotes policies for which NAACOS has advocated.