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Frustrated with annual scrambles to fix payment challenges posed nearly every year by the Medicare physician fee schedule, a group of nearly 100 health care provider and patient advocacy organizations including APTA has sent a message to Congress: It's time to talk about overhauling payment, because the current system isn't working for anyone.

In a letter to the chairs and ranking members of the Finance, Ways and Means, and Energy and Commerce committees in the U.S. Senate and House of Representatives, 96 organizations are calling on Congress to "immediately initiate formal proceedings (hearings, roundtables, expert panels, etc.) to discuss potential reforms to the Medicare physician payment system to ensure continued beneficiary access to care."

The letter targets both the fee schedule and the Medicare Access and CHIP Reauthorization Act's Quality Payment Program, or MACRA QPP, as fundamentally flawed systems in need of overhaul. The organizations call out the fee schedule's budget neutrality requirements and lack of annual inflation-related increases as particularly problematic. They also characterize the QPP's Merit-based Incentive Payment System, or MIPS, as a program that has never delivered on its promise of incentive payments sufficient to buffer the impact of cuts.

"The inherent instability of the MPFS, coupled with the shortcomings of MACRA's QPP, has created an environment where many practices have seen their payments decrease year-over-year, despite increasing costs and growing inflation," the letter states.

The organizations, which include APTA, American Medical Association, Alliance for Recovery Care, National Association of Rehabilitation Providers and Agencies, American College of Cardiology, and American Academy of Family Physician among others, acknowledge the ways that Congress has helped to mitigate some of the fee schedule cuts, particularly during the pandemic, but assert that now's the time to address "systemic" issues in the payment system. "Millions of seniors rely on the Medicare program," the letter states," and we must work to ensure it remains a robust and dependable option for those who need it the most."

The notion that the fee schedule and MIPS are in need of serious repair isn't a new one, according to APTA Government Affairs Vice President Justin Elliott, but the pandemic has pushed the issue closer to a tipping point.

"APTA and many other organizations have said for years that the physician fee schedule is outmoded, is administratively burdensome, and does not pay for the value that providers, such as physical therapists, bring to the health care system," Elliott said. "Many legislators have become acutely aware of how they're asked to step in, year after year, to patch up at least some of the damage inflicted by payment cuts, and when CMS marched ahead with cuts during the pandemic, even more lawmakers took notice. That opens the possibility for some productive dialog about systemic change and larger reforms."

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