TMA Ask the Expert: Medicare Physician Fee Schedule
By Emma Freer

The Centers for Medicare & Medicaid Services’ (CMS’) 2022 Medicare Physician Fee Schedule takes effect on Jan. 1 and raises several concerns for physicians treating Medicare patients, including a series of mandated pay cuts totaling nearly 10% and changes to the already complex Quality Payment Program (QPP).

But now you can take advantage of guidance the Texas Medical Association shared on this topic during its latest Ask the Expert event, Medicare Physician Fee Schedule. The recorded session is free to TMA members as a CME to Go program for which you can earn 0.5 AMA PRA Category 1 Credits™ and 0.5 ethics credits. It will be available in the TMA Education Center later this month.

Robert Bennett, TMA’s vice president of medical economics, says the annual regulation often prompts a sense of déjà vu, bringing with it new questions and the specter of additional administrative hassles. He adds that physicians are most concerned about the pay cuts, which will arrive amid the COVID-19 pandemic and could further constrain access to care.

“These [are] … budgetary gimmicks that Congress is using to not pay for services that are actually being rendered,” he said.

A recent TMA member survey found 62% of Texas physicians may be forced to stop seeing any new Medicare patients if the cuts are enacted Jan. 1 as scheduled.

Although Mr. Bennett believes Congress will address the cuts, citing ongoing advocacy by TMA and its members, he says lawmakers may wait until early 2022 to address them retroactively. You can encourage them to reconsider by downloading TMA’s advocacy toolkit, Medicare Cuts: Insult Upon Injury, complete with background information on the issue, social media posts, and advocacy messages you can use to share your concerns with lawmakers and others.

Shannon Vogel, TMA’s associate vice president of health information technology, says physicians are also worried about the growing complexity of the Merit-Based Incentive Payment System (MIPS), a participation track in the QPP. The 2022 fee schedule updates to MIPS include:

  • Increasing the cost category weight from 20% to 30%;
  • Changing some of the category measures; and
  • Raising the performance threshold from 60 points to 75.

Physicians’ performance in MIPS in 2022 affects their 2024 payments.

“Physicians are very, very busy, and then to add some of these regulations to something that is already confusing to comply with in individual practice makes it really difficult and adds to the burden,” Ms. Vogel said. (For the 2021 MIPS performance year, many physicians will qualify for a hardship exemption because of the pandemic.)

TMA experts also highlighted some silver linings to the forthcoming fee schedule. CMS heeded TMA's advocacy in extending coverage for all services added to the Medicare telehealth services list during the pandemic through 2023. The agency adopted most of the American Medical Association’s Relative Value Scale Update Committee recommendations regarding payments for physician services, and delayed the payment penalty phase of Medicare’s appropriate use criteria program until at least 2023.

Additionally, for 2022, CMS did not adopt a proposal that would have required physicians to indefinitely retain patient health information, which TMA had strongly opposed. However, CMS indicated the issue could be revisited in future rulemaking.

Visit TMA’s Ask the Expert webpage to find previous recordings in the series and to stay up to date on 2022 programs.

Last Updated On

December 02, 2021

Originally Published On

December 01, 2021

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Emma Freer


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Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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