By Jeff Elton, PhD, CEO, ConcertAI
On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule and Quality Payment Program proposed rule for 2025 and the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule for the same period. These policies advance a combination of policy and coding changes that CMS estimates as having a neutral financial impact on hematology, oncology, and radiation oncology practices for CY2025. This assessment is incomplete as it does not fully recognize that changes to the 2025 Resource-Based Relative Value Scale conversion factor (CF) would represent a 2.8% reduction from 2024 to 2025, and that this could be higher or lower depending on geography and the combination of Medicare services billed. This essentially constitutes a reduction in reimbursement for oncology care that would be on top of higher costs for delivering that care – here, CMS projects that the Medicare Economic Index (MEI) would be 3.6% higher.
All in all, the net negative impact of the proposed changes for 2025 on oncology, hematology, and radiation oncology practices may be a total effective decrease of 5% to 6% when accounting for reimbursement reductions and higher costs to provide clinical services, with variations based on region and Medicare service mix.
Organizations such as the American Society of Clinical Oncology (ASCO) support H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would provide a permanent, annual reimbursement update equal to the increase in the MEI. This allows practices to make the investments required to provide high-quality and equitable care – a best practice for any enterprise, but especially where the rate of innovation and change are high. Our view is that these sorts of modifications are critical.
Cancer lives have been saved by integrating the latest medical innovations into clinical practice and making them available in all settings – academic, regional, and community. Reducing the capacity of healthcare providers to make the necessary investments to stay abreast of these innovations threatens to erode the care capacity and capabilities available to patients, especially in the community where 80% of patients receive their care – something we have a solemn responsibility to avoid.
