Government Shutdown Could Delay Medicare Claims Payments, Reform
By Emma Freer

The looming federal government shutdown would have ramifications for physicians across the country as well as for desperately needed Medicare physician payment reform.  

Congress recently passed a short-term spending bill funding the federal government – and delaying a shutdown – through Nov. 17. But its members remain deadlocked on a broader spending package for the current fiscal year, which began Oct. 1. If they can’t reach an agreement or pass another short-term spending bill by midnight on Nov. 16, the government will shut down. 

In such a scenario, physicians will be impacted in several ways, ranging from payment to quality programs, according to the American Medical Association.  

Although the Centers for Medicare & Medicaid Services (CMS) will continue to process claims, a shutdown could hold up funding to Medicare administrator contractors, who issue physician payments. 

CMS also would furlough approximately half of its employees, which could limit the federal agency’s ability to respond to physicians’ questions about Medicare policies or scores under the Merit-Based Incentive Payment System (MIPS). In recent months, AMA has fielded reports from physicians receiving their first-ever penalties under MIPS for the 2022 performance year, which could affect 2024 payments by as much as 9%.  

If the shutdown is prolonged, it also could delay the release of the 2024 Medicare physician fee schedule, expected in early November; new alternative payment models; and other major regulations, according to AMA.  

TMA has serious concerns about CMS’ proposed fee schedule, which would deepen physician pay cuts and increase complexities associated with MIPS. The association recommended several updates in a lengthy Sept. 8 comment letter to CMS. 

TMA also strongly supports the bipartisan Strengthening Medicare for Patients and Providers Act (House Resolution 2474) and recently met with lead bill sponsors to expedite passage of the legislation, which would provide annual inflationary updates to the Medicare physician fee schedule in line with the Medicare Economic Index, a measure of practice cost inflation.  

Robert Bennett, TMA’s vice president of medical economics, says a shutdown would eclipse other legislative business and add to the obstacles in HR 2474’s path to passage. 

In more positive news, a shutdown would have little impact on certain other federal government functions that are relevant to physicians, according to AMA. These include: 

  • The Department of Health and Human Services’ research, vaccine and therapeutic development, and federal health insurance marketplace activities; 
  •  The Substance Abuse and Mental Health Services Administration’s critical behavioral health resources in the event of a disaster and its 988 Suicide Lifeline, among other programs; 
  • The Administration for Strategic Preparedness and Response’s maintenance of minimum readiness for all hazards, including COVID-19, pandemic flu, and hurricane responses; 
  • The National Institutes of Health’s research and clinical activities; and 
  • The Food and Drug Administration’s drug and medical device reviews, emergency use authorizations, and other emergency responses, such as monitoring for outbreaks related to foodborne illness and the flu.  

TMA equips you with the information you need to help stop looming Medicare physician pay cuts. Get involved in this crucial advocacy effort with ready-made social media graphics and posts, sample letters to the editor, a sample op-ed, and an Action Alert to send directly to legislators by downloading the toolkit.  

Last Updated On

October 18, 2023

Originally Published On

October 18, 2023

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Emma Freer

Associate Editor

(512) 370-1383

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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