CMS Provides Little Relief for Anesthesia Groups in Release of 2023 Payment Rules

On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released its Calendar Year (CY) 2023 Medicare Physician Fee Schedule (PFS) final rule, which includes finalized policies related to Medicare physician payment and the Quality Payment Program (QPP). Unless otherwise noted, finalized policies, including changes to the Anesthesia Conversion Factor, work Relative Value Units (RVUs) for several pain medicine codes, and policy updates for the 2023 QPP performance year will be effective January 1, 2023. Absent Congressional action, all physician practices - including anesthesiologists and their groups - will face significant Medicare payments cuts next year. 

Within the fee schedule, CMS finalized Medicare payment cuts to the Anesthesia Conversion Factor and the bundling of certain procedure codes that will only compound the financial strain that anesthesia groups are already facing. The final rule underscores how the Medicare payment system is broken, especially during a time when anesthesia groups are faced with inflation pressures and the COVID-19 pandemic. ASA has urged and will continue to advocate to legislative stakeholders and regulatory agencies to minimize and reverse these cuts that negatively impact anesthesiologists.

Payment Provisions

CMS has finalized significant cuts to the anesthesia and RBRVS conversion factors (CF) for CY 2023. The 2023 finalized anesthesia CF is $20.6097, representing a decrease of 4.42% from the 2022 anesthesia CF of $21.5623. The 2023 finalized RBRVS CF is $33.0607, representing a decrease of 4.47% from the 2022 RBRVS CF of $34.6062. 

Initially, CMS had proposed a 3.91% reduction from the final 2022 anesthesia CF and a 4.42% reduction from the final 2022 RBRVS CF. While this finalized conversion factor represents a reduction over the proposed rule, Congress is still considering potential relief in an end-of-year legislative package. In addition, physicians and other health care professionals are facing reinstatement of a 2% sequestration cut plus a 4% PAYGO cut that is part of the American Rescue Plan. ASA is working with other specialties on a comprehensive approach to patching these cuts for 2023.

As published in the 2023 Final Rule, anesthesiologists can expect these conversion factor payments:

Code Level Changes

Anesthesiologists and those who deliver pain medicine will have new relative value units for seven Somatic Nerve Injection CPT codes. 

* Note that these codes now include imaging as shown in the code descriptions

ASA met with CMS to discuss the proposed value reductions to many of the pain codes listed above. In the final rule, CMS stated that the agency found the additional clinical information provided by ASA helpful in understanding the intensity of the work associated with these services. In light of this additional information, CMS agreed that the RUC recommendation better supports relativity. ASA is pleased with CMS's decision to finalize RUC-recommended values and not further decrease the payments of the somatic nerve injection codes as was proposed.

The magnitude of these cuts to the Anesthesia and RBRVS CFs is significant and will potentially have a devastating impact on physician practices while the country continues to struggle with the COVID-19 pandemic, evolving variants, rising inflation, health care worker burnout, staffing shortages, and regulatory requirements that increase administrative burden on practices. Absent Congressional action, physicians are facing a 10% payment cut in CY 2023 taking into account the negative update to the Anesthesia and RBRVS CFs, Medicare Sequestration (2%), and PAYGO Sequestration (4%). ASA fears these drastic cuts will put practices and patients’ access to care at risk.

Other Payment Policies

In September 2022, ASA submitted responses to several other proposals for the 2023 MPFS. Among others, responses included ASA support for CMS’s proposal to establish new coding and billing for chronic pain management services. CMS also stated their intention to refine its practice expense (PE) methodology for future rulemaking, including using more current and routinely updated data sources to reflect current costs associated with running a practice.

For questions on the Medicare Physician Fee Schedule, contact Helen Olkaba, ASA Director of Payment and Practice Management, at [email protected].

Quality Provisions

The 2023 Quality Payment Program final rule also provided details on how anesthesiologists and their groups can participate in the Merit-based Incentive Payment System (MIPS), MIPS Value Pathways (MVPs), and Alternative Payment Models next year. In general, anesthesiologists will see consistency from 2022 to 2023 and should check with CMS and ASA in the coming months for direction on reporting an MVP. 

CMS amended the anesthesiology measure set by removing MIPS 76: Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections from the MIPS program altogether, citing its topped-out status. CMS did not finalize the Screening for Social Drivers of Health measure for the anesthesiology measure set. 

ASA is excited that CMS finalized the Anesthesiology MVP for the 2023 reporting year with minor changes. ASA advocated for the inclusion of an anesthesiology-specific MVP for several years and believes the MVP will reduce burden for most anesthesiologists and their groups. ASA expects that CMS will release additional details on how an individual or group can report an MVP in 2023.

ASA was also successful in delaying the onerous and one-size-fits-all measure testing requirements that CMS intended to implement this year. The delay will allow anesthesiologists and their groups continued access to valid QCDR measures that improve care, reduce costs, and reflect current practice workflows. 

In 2023, QPP participants will mostly see continuity in most features of the program:

• The MIPS performance threshold will be set at 75 points. Individuals and groups receiving less than 75 points will incur a payment penalty on a linear sliding scale up to 9% with those scoring under 18.75 points incurring an automatic -9% adjustment. Unless Congress acts, there is no exceptional performance bonus for 2023. 
• The quality and cost performance categories will be equally weighted at 30% of the total MIPS score. Promoting interoperability and Improvement Activities performance categories will maintain their respective 25% and 15% weights.
• CMS retired MIPS 76: Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections measure from the MIPS program.
• For the quality performance category, MIPS participants will still need to report at least 70% of their total cases for each selected measure. 

ASA expects to update its Quality Payment Program website in the next few weeks with regulatory information. The Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR) expects to publish its 2023 QCDR measures book in late December. CMS expects to publish the 2023 MIPS measure specifications and other regulatory guidance within the next few weeks on the QPP website. 

For more information on these issues, please contact the ASA Department of Quality and Regulatory Affairs (QRA) at [email protected].