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Access & Reimbursement

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Fair and adequate reimbursement for infectious diseases physicians is a key IDSA policy priority. The Society also advocates for access to appropriate treatments for patients with serious infections and for medical liability reform. IDSA’s positions on specific reimbursement and access issues that impact the practice of infectious diseases and Advocacy Alerts to key policy priorities are provided below.


2023 Medicare Physician Fee Schedule Proposed Rule: Initial IDSA Response

On July 7, the Centers for Medicare and Medicaid Services (CMS) released its calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) proposed rule. Key elements of the proposed rule are summarized below. ID physicians are expected to receive 5% overall increase in payments under the proposal, while most other specialties are facing cuts. IDSA is advocating for a stronger approach to updating inpatient E/M services that should result in a larger increase for ID physicians. IDSA will continue to share additional information about the proposed rule and will call on all of you to help us advocate to CMS and Congress. Read More.

 

IDSA Comments on the Medicare and Medicaid Programs, Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care (PDF)

IDSA provides comments on the proposed regulation regarding Medicare and Medicaid Programs; Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care. The comment letter stresses the importance of infectious diseases physician leadership in infection control and prevention programs as well as strongly supporting proposed changes relating to adherence to national infection prevention and control guidelines, organizational accountability for healthcare acquired infections (HAIs), responsibilities of the infection preventionist/infection control professional, and medical record services.

IDSA Jointly Comments on Medicare and Medicaid Programs' Condition of Participation for Antimicrobial Stewardship (PDF)

IDSA, in collaboration with SHEA, jointly provides comments on the proposed rule regarding Medicare and Medicaid Programs; Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care. The comment letter stresses the importance of antimicrobial stewardship programs (ASPs) and IDSA and SHEA's strong support of the proposal to require ASPs at acute care and critical access hospitals (CAHs). Furthermore, we provide comments on leadership of ASPs, ASP leadership's separate designation from infection preventionist/infection control professionals, ASPs measures of success, and tele-stewardship models to serve CAHs.

IDSA Comments on the Merit Based Incentive Payment System and Alternative Payment Model Incentive Under the Physician Fee Schedule (PDF)

IDSA provides comments on the Merit Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule regarding the impact of the new quality payment program on the specialty of infectious diseases. Specifically, comments are provided on quality measures under MIPS, hospital-based physicians, development and implementation of quality measures, submission mechanisms, reporting on outcomes and high priority measures, threshold for data completeness, clarification on scoring of quality measurement under MIPS, specialty-specific measures, quality clinical data registries (QCDRs), virtual groups, quality performance period, and APMs. Furthermore, IDSA provides suggestions for clinical practice improvement activities (CPIAs) under MIPS that include antimicrobial stewardship programs, emergency response and preparedness, telehealth services, and CME.

IDSA Joins Other Medical Societies to Raise Awareness of Physicians’ Concerns Regarding the Implementation of MACRA (PDF)

IDSA jointly expresses concerns regarding the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). More specifically, comments are provided on the following overarching issues, ensuring that the implementation of MACRA does not disrupt the positive effect Alternative Payment Models (APMs) are having on beneficiaries' health in the public and private sector, the need for a clear pathway for private sector models to meet the threshold for qualifying APMs under MACRA, virtual groups in the Merit-Based Incentive Payment System (MIPS) should be defined to help small, independent physician practices remain viable, and existing clinical quality improvement activities should satisfactorily meet MIPS requirements.

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