Latest / Off the Chart: A Business of Medicine Podcast / Special Report: Medicare’s final 2027 fee schedule cuts deeper than proposed, with Taya Gordon of Atlas & Perpetua Healthcare Consulting
Transcript
- Speaker 1 0:00 It almost feels like the SGR all over again. You know, I'm I'm feeling you know that triggered by the SGR way back in the day. We thought we moved away from it. Here we are, so many years later, we're still taking annual cuts. Hey there, Physicians Practice 0:25 folks, and welcome to this Off the Chart of Business of Medicine podcast special report. My name is Keith Reynolds, managing editor of Physicians Practice, and I'd like to thank you for joining us today. On Wednesday evening, november 4, CMS released the final 2027 Medicare physician fee schedule. There are some big changes coming January 1st, including a deeper overall cut than was proposed back in July, and a less steep cut to Multiplier 25. To try and get a handle on some of these changes, this morning I sat down with Taya Gordon, CEO of Atlas and Perpetua Healthcare Consulting, to get her first read. We talked about why the smaller modifier 25 cut will still hurt some specialties, how the G2211 switch could throw off 2027 budgets. The one table in the rule she always reads first, and what she do as a practice administrator this week. Taya Gordon, thanks for joining us, and now let's get into the episode. Hey there, folks! Today we're talking to Taya Gordon, and we are talking the Medicare physician fee schedule 2027. Taya, how you doing today? Speaker 1 1:28 Oh, so far so good. I stayed up a little too late reading the new rule, though. Physicians Practice 1:32 Let's dig right into it. You know what's what's your what's your top takeaways? You know what are you what are your thoughts reading it? Speaker 1 1:39 You know, every year when we get the final rule back, I'm. I think I go first to the comments to see what did they finalize, but also what did they not finalize. I think there's sometimes misconception that they just are going to push everything through anyway. But you can always see evidence that they really took our comments and heard it, and I think that was really evident with what they decided to do with modifier 25, I still don't love the change. I would love to not see an impact to reimbursement, but the fact that they shrunk it down, which we can talk about, and the fact that they're only putting it forward at 20% and for the zero day global, that kind of thing, it makes me feel heard as an industry human in healthcare. So I did see some evidence of you know them trying to meet us in the middle, which felt good. Physicians Practice 2:24 All right, so let's dig right in on modifier 25. Like you said, they went from the proposed 50% cut, which was very doom and gloom, to you know 20% and limited it to zero day global procedures. You know, tell me what's your take on it? You know, is is did we did we can we count this as a win or is it still just a real knife in the back? Speaker 1 2:48 You know, I don't think we can ever count things as a win when they're still as complicated as they are. I'm so jaded in that regard. If it takes us, you know, 15 steps to figure out what what we're gonna get paid, I think that's too complicated and it's not a win. But I do think that things shifted in our favor because a 50% reduction in reimbursement was going to be pretty devastating to most groups. And you and I talked about it a little bit before, just what they were saying out in the industry. Some people saying, "Well, then I'm not going to do more than one procedure in a day, or I'm going to tell patients they have to come back." And we were seeing kind of this negative immediate reaction, so I'm happy to see that's been significantly reduced. I do think it's going to still impact some specialties pretty heavily. I think when you talk about orthopedics and primary care taking that 20% cut on a second procedure, they're going to see pretty often, and that doesn't really feel good. Physicians Practice 3:40 Most clinicians are also facing a 2.31% conversion factor cut. You know what is january 1 going to look like for procedure heavy practices? Speaker 1 3:50 This is probably the saddest part. I think we're so used to taking reimbursement discounts at this point that so many of us, at least those that I've been talking to since this dropped, we're like, all right, well, taking a hit again. You know, it's been so long, and there's all those charts and graphs that show, you know, the cost rising and supply cost rising and staff cost rising, and our reimbursement hasn't really changed. And I think if we hadn't seen that two and a half percentage, you know, that one year increase that that we had, I think if that wasn't going away, we might have had a tiny increase. But either way, seeing a decrease again, it just feels like it almost feels like the SGR all over again. You know, I'm feeling you know that triggered by the SGR way back in the day. We thought we moved away from it. Here we are, so many years later, we're still taking annual cuts, and the only way for us to avoid them annually has been trying to get some end of year rapid legislation pushed through, which probably isn't going to happen this year. I would imagine during that lame duck period. So it's just, I mean, maybe it's only me, but I feel like okay, well, here we go again with another another reduction. It doesn't feel like the biggest piece of the story to me, but obviously. I also don't like it. I would love to see us get a nice big bump. It's it's overdue. Physicians Practice 5:05 So you know, just thinking about you know running a practice, what's the biggest thing a building team needs to change on modifier 25 before january 1? Speaker 1 5:15 I think the biggest thing is education. I think it's going to be very confusing to a lot of different groups, and not just your internal teams. I think the biggest challenges are going to be making sure everybody understands when it applies and when it doesn't, so that they can appeal properly. Because as different payers start to deploy this, we know, right? Most of them will see what CMS is doing, then they'll try to follow along. As they start to attempt to match to the same thing, we're probably going to see some confusion, or we're going to see some different interpretations of how that's listed. So it's going to be really important that your team not only understands when it applies and when it's appropriate, but that they know how to appeal it. That you have built out systems in your own practice management programs and platforms so that they can catch things if they're not being paid correctly. So I think most of this is going to come down to educating your team, building out those alert systems, and then high levels of communication as it trickles through the industry. And I would also highly recommend that they just start looking out for payer bulletins and notifications to see what those other payers are doing. Physicians Practice 6:17 Alrighty, so g20 211, it's becoming modifier b1 easier to say, but it's adding 16% to the E and M visit instead of a flat rate. Where can that switch trip up a practice? Speaker 1 6:30 You know, I don't, I don't hate this one. I might, I might get some shade for that. I don't hate this one because I've seen it be implemented incorrectly so much this year. I've seen a lot of groups who just started putting it on every single visit, every single time they're adding this, and that's just not appropriate. I mean, there's no CPT codes or HCPCS codes that we build every single visit, every single time. And if it is something that really is tied that closely to an E and M code, it, in my opinion, it makes sense for it to be a modifier. The it moving from a flat fee to being a percentage is a challenge. I think because you don't often see that happen. Where this is the flat rate, this is something you can forecast off of. And I think a lot of groups have already completed their budgets and forecasts for 2027. So when you look at something like this, saying okay, instead of this, you know, we have these units and these volumes expected. Instead of that, like strike all of that. Now it's going to be a percentage basis. I think what's going to trip them up is understanding what they're supposed to be reimbursed. Instead of it saying you know this is our dollar amount that we can count on, now it's a percentage basis. And of course those change based on you know which type of provider is doing it, which specialty, which region, all of that, so it's a big difference, I think, for them to to try to understand. But I don't hate the change because I think it will create a little bit less inappropriate use of the of the services. And I'm also hopeful that with it being included in there as a modifier, that there'll be a little bit greater education and understanding by some of the providers who are using it historically, I don't want to generalize, but I say historically most clinicians focus on the codes, the diagnosis codes, CPT codes, documentation, and they leave a lot of the modifiers to the billing department because of the complex nature of it. This is one of those areas where they're going to kind of have to come together. So I'm hoping it bridges some communications a little bit too. Physicians Practice 8:22 So, sort of the impetus of us talking this early in the morning was a LinkedIn post that you threw up that was very informative. Within that, you told people it's time to share this with their team. If you're a practice administrator, what's the first thing you do this week? Speaker 1 8:38 Oh, 100%. I'm having a team meeting. I think the thing is we wait for a long time to get these this information. We're waiting for the fees that are going to be in 2027. We want to know the rule changes. One of the biggest things that was kind of looming were the changes potentially to RPM and RTM, and whether or not they were going to push forward that doing that type of remote management could only be done by an employee, and so you had 60 days where you're. I mean, hopefully you have 60 days, right? Where you're hoping the final rule comes out before the end of the year, where you can maybe change your entire processes. A lot of groups have outsourced that. So my recommendation to everybody back in July was read through this. Look at what's potentially coming, and know your paths. If CMS goes left, this is what we'll do. If they go right, this is what we'll do. If they go down the middle, this is what we're going to do. And that way, you knew whichever way this proposed rule for every little activity went, what you were going to do next. It the groups that did that, their Monday morning meeting is okay. Now we know what they did. Let's implement the strategies that we prepared for. For the groups that didn't, that were like, I'm just waiting for the final rule. Just tell me how bad it is, right? There's some of those that are like, I'm not going to spend months thinking about this. Just tell me when you know. For those, this is their first time looking at that, and this is their first time getting to see all of the changes and things that they want to, that they need to implement. So. Luckily, RPM and RTM that specific change got punted a little bit longer out, but there were changes that are immediately effective in January one. Like it can only be for established patients if it's RTM and and some things like that. So I think it's going to be about sitting down with your team, billing, your administrative team, anybody who's touching the revenue cycle. I would include where appropriate, and talk to them about the changes and the ones that impact your clinic. One of the coolest things that they put in there is an impact analysis table, and I mean most people probably don't read all the 1000s of pages in there. But the impact analysis table I love because they take into account all of the changes that they're doing, and then they say by specialty we think this is how it's going to impact your reimbursement, whether you're facility, non-facility. Like they break that out. As a practice administrator, it was one of the first things I always went to to see the difference between the proposed rules table and the final rules table because that told me how much is this going to impact the organization, how much of it have I not already considered. So, for example, if in July it said you're probably going to have about a 4% decrease. Then in November, when I look at the table, if it says you're probably at net neutral, I'm like, okay, a bunch of the things I was concerned about impacting our revenue are probably gone. That tells you you can take a breath. But either way, you have to really dig into that. There's a ton of fact sheets available at the CMS newsroom. Industry giants are going to start issuing them. I think MGM may already sent out like a summary email, and then they're going to push out their greater one. And you'll start to see that from all the other big organizations in the industry. Read through those, figure out what applies to your clinic, and then make sure that you've sat down with your team and kind of educated them because these changes we have less than 60 days now, and we've got to get them implemented. I Physicians Practice 11:40 think that's all I got for you. Is there anything else you want to add? Anything you think I'm overlooking? Speaker 1 11:44 I don't think so. I mean, it's just it's so much to kind of digest and absorb. I think we're all still in early days, and some of the summaries that come out from those big known organizations are going to be the most useful to us. And I'm interested to see what everybody else's biggest takeaways and pain points are Physicians Practice 12:01 alrighty. Well, we're going to try to collect all that as much as we can here on Physicians Practice. So keep checking out the site. All right, Taya, thank you so much for chatting. It is always a pleasure. Speaker 1 12:10 Thank you so much. Thanks for having me. Appreciate it. Physicians Practice 12:20 Once again, that was my conversation with Taya Gordon, CEO of Atlas and Perpetua Healthcare Consulting. For our full coverage of the 2027 Physician Fee Schedule final rule, visit medicaleconomics.com and physicianspractice.com. You can hear more from Taya on Thursday, November 19th, at the Medical Economics Practice Academy. Beneath the surface, efficiency, revenue, and burnout. It's a free virtual event from 1 to 4 p.m. Eastern, and at 2 p.m., Taya leads a session on finding the revenue cycle problems that hide inside numbers like days in accounts receivable and denial rates. The registration link is in the show notes below. My name is Keith Reynolds, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show, and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories medical economics and physicians' practice published, delivered straight to your email six days of the week. Subscribe to our newsletter at medicaleconomics.com and physicianspractice.com. Off the chart, a business of medicine podcast is executive produced by Chris Mazzolini and myself, Keith Reynolds, and produced by Austin Latrell. Medical Economics and Physicians Practice are both members of the MJA Life Sciences family. Thank you.