Proposed CMS Conversion Factor Is Lowest In 20 Years

Sarasota, FL (WorkersCompensation.com) – While CMS is making an effort to support vital rural hospitals in the proposed rules for 2023, the proposed cuts for physicians could potentially mean there are fewer physicians to take call. While the proposed rule is advertised as a way to expand access to high quality care, certain physician groups feel that the proposals actually threatens patient access. 

In a press release earlier this month, CMS has proposed a decrease in the conversion in a time when operational business costs are at an all-time high. Under the new rule, the current conversion factor of $34.61 would drop by $1.53 to $33.08, which equates to a decrease of 4.43 percent.

According to the conversion factory history from the American Medical Association (AMA), since 2000, the highest conversion rate assigned has been $38.2581 in 2001, which at that time represented a 4.5 percent increase. By comparison, the lowest conversion factor since then was in 2011 at $33.9764. Although the 2011 rate equated to a 7.9 percent drop over the previous year, it is still not quite 3 percent higher than 2023 proposed rate. When averaged out, the conversion factor average since 2000 is $36.1944, and the average change from year to year has been .0288 percent.

The AMA issued a press release stating that the proposed cut would threaten patient access in addition to creating long-term financial instability for providers. The AMA also stated that in response they have developed a set of principles on payment reform as part of the AMA Recovery Plan For America’s Physicians. The principals listed include a financial baseline that reflects inflation and costs, recognition of fiscal responsibility and outcomes, encouraging collaboration and patient choice, improvements in value base care, and advances in health equity. Additionally, part of the Recovery plan includes addressing prior authorization issues, supporting telehealth, reducing physician burnout, among other initiatives.

Aside from the reduction of the conversion factor, CMS is proposing changes impacting behavioral health, allowing licensed professional counselors and therapists to provide services under general supervision instead of direct supervision. CMS is also proposing that clinical psychologists and licensed clinical social workers provide therapy as part of the patient’s primary care team.

Another proposed change includes bundling of certain chronic pain management and treatment into new monthly payments. In addition, the proposal also includes opioid and recovery treatment in mobile units to address rural areas and homeless patients.

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