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June 3, 2023

Contact: Grant Herring

USPA Says Perfect Storm Is Here Due to New Cuts
in Medicare Physician Fee Schedule 


USPA calls for Congress to support H.R. 3674


 WASHINGTON, DC — Today, United Specialists for Patient Access (USPA) voiced its strong objection to the proposed cuts included in the 2024 Medicare Physician Fee Schedule (MPFS) released last week by the Centers for Medicare & Medicaid Services (CMS).


As drafted, the MPFS will make significant cuts to specialty care providers in the office-based setting. These reimbursement reductions follow year-over-year cuts, including clinical labor cuts, to the MPFS directed by the Centers for Medicare & Medicaid Services (CMS).


USPA is categorizing the latest round of cuts as a perfect storm. The organization is calling on Congress to pass the Providing Relief and Stability for Medicare Patients Act of 2023 (H.R. 3674) to remedy the actions of CMS.


Dr. Mark Garcia, USPA board member and CMO for American Vascular Associates, said, “This proposed rule change and the ongoing cuts to office-based providers are causing a perfect storm that will wipe out specialists and patient access to quality care. As constituted, the new rule will contribute to undermining patient access and widening the health equity gap because office-based providers will be forced out of business. Specialists cannot continue to see dramatic cuts year after year, manage record inflation, treat COVID-19, and at the same time continue to provide quality care to patients.” 


“From 2006 onwards, we have witnessed a persistent decline in funding for office-based specialists, with an average reduction of approximately 30% in the Physician Fee Schedule. The detrimental effects have been exacerbated by the pandemic and soaring inflation rates. Record numbers of office-based centers have already shuttered, and if further cuts to the PFS continue, this trend will escalate rapidly. As a consequence, patients will be compelled to seek care in hospitals, resulting in higher costs and increased burdens. It is imperative that Congress H.R. 3674 to stop mitigate these looming cuts to office-based specialists."


The Cause of the Perfect Storm:


  • Ongoing clinical labor cuts to office-based specialists.

  • CMS-initiated cuts are layered on top of inflationary pressures; the MPFS pie hasn’t increased to keep pace with inflation. 

  • Disparities in payment between hospitals and office-based providers.

  • MPFS rebalancing policies of reimbursement away from specialty care.

  • Specialty providers are squeezed so hard that they can’t stay in business and are forced to be acquired; causing health system consolidation and more expensive care. 

  • Damage caused by MIPS to independent practices (According to a study in JAMA, MIPS eligible clinicians affiliated with better resourced health systems were associated with significantly better 2019 MIPS performance scores).


The Impact of the Perfect Storm:

  • Undermining patients’ access to care, particularly in rural and underserved areas. 

  • Widening the health equity gap.

  • Higher costs as patients are forced to the hospital setting for care, which can be far more costly and burdensome than the office-based lab.


The Solution:

  • USPA has endorsed the Providing Relief and Stability for Medicare Patients Act of 2023 (H.R. 3674), introduced by Rep. Gus Bilirakis (R-FL-12), Rep. Tony Cardenas (D-CA-29), Rep. Greg Murphy, MD (R-NC-3), and Rep. Danny Davis (IL-D-7).

  • Physician payments under the MPFS = RVUs (relative value units) * conversion factor.  H.R. 3674 addresses ongoing RVU cuts due to the clinical labor policy and other policies which have been the main source of office-based specialty cuts in recent years.

  • Together with the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which addresses ongoing conversion factor cuts, H.R. 3674 will prevent major disruptions to care while addressing concerns about the future of Medicare physician payments.  

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