HFMA provides an update to its detailed specialty impact analyses based on the updated 2024 Physician Fee Schedule (PFS) national relative value unit (RVU) contractor file posted on January 3, 2024. There was almost no change to the specialty impacts given the small changes in the updated 2024 PFS RVU contractor file to practice expense RVUs for about 250 codes. For completeness and accuracy, we updated the specialty impact tables. The specialty impact analyses are contained in one spreadsheet that includes information on almost all the designated Medicare specialties (over 80) and the associated detail. This includes, for example, cardiology, emergency medicine, family practice, general surgery, internal medicine, radiology, radiation oncology, podiatry, and rheumatology. Choose the specialty of interest, such as family practice in a dropdown box, and the spreadsheet displays the overall impact for that specialty and detail code level information on the top 250 codes as ranked by estimated 2024 total payment. There is also a separate spreadsheet tab that shows the overall estimated impacts by specialty – similar to the regulatory impact table in the Medicare PFS final rule.
It is helpful to note that the estimated specialty impacts provided vary from CMS’ regulatory impact table (Table 118). CMS’ regulatory impact shows the changes to relative value units (RVUs) for specific services and the third-year transition to updated clinical labor pricing. It also includes changes in spending which result from finalized policies within budget neutrality (BN), such as the updated policies associated with the complexity add-on code G2211. These payment impacts, however, do not take into account the impact of the 2.50 and the 1.25 payment supplements for 2023 and 2024, as these are statutory changes that take place outside of BN requirements. The estimates, however, include the combined effect of RVU changes and the conversion factor (CF) changes associated with the Consolidated Appropriations Act, 2023, and thus the effects are larger. For example, if CMS specifies a -2 percent reduction for a given specialty in Table 104, the combined effect of RVU changes and the net decrease to the PFS CF from the statutory changes would be roughly -3.25 percent in the estimates. CMS displays the combined impact percentage in Table 118 to the nearest whole number so adjusting these numbers for the net decrease of 1.25 percent is an approximation.
Note: 2024 PFS payment rates may be impacted by ongoing negotiations in Washington, early 2024.