What to Know About Congress’ End of the Year Spending Package

On Friday December 23rd, Congress enacted a year-end “Omnibus,” which funds the federal government through the 2023 fiscal year. The legislation included provisions aimed at addressing the two looming physician payment reductions. The package averted the 4% PAYGO sequestration cut in its entirety for 2023 and 2024. With regard to the almost 4.5% reduction to the Medicare Physician Fee Schedule conversion factor, the legislation only partially averted that reduction by offsetting 2.5% of it in 2023. After this legislative intervention, the revised 2023 Medicare Physician Fee Schedule conversion factor is $33.8872, which is approximately 2% less than the 2022 conversion factor.

At over 4,000 pages, the Omnibus addressed many topics in addition to physician reimbursement. Below is a brief overview of some of the provisions of highest interest to breast surgeons, several of which ASBrS worked on throughout the last Congress.

• Breast Cancer Research Funding. Finally, the bill provides significant support for medical research via a funding increase for the National Institutes of Health (NIH), but also directs funding to breast cancer programs in other agencies. For example, the bill provides $1.4 billion for Chronic Disease Prevention and Health Promotion within the Centers for Disease Control and Prevention (CDC), of which $235.5 million is directed to the Breast and Cervical Cancer line item and another $6.9 million to Breast Cancer Awareness for Young Women. ASBrS had previously weighed in with the Senate Appropriations Committee Labor-Health and Human Services Subcommittee to express support for these programs.
• USPSTF Breast Cancer Screening Guidelines Moratorium. The legislation extended a moratorium on breast cancer screening guidelines from the U.S. Preventive Services Task Force (USPSTF). This moratorium was first put in place by Congress in 2015, after revised guidelines by the USPSTF recommended less frequent screening for women under fifty than previous guidelines. The Omnibus’ extension, which runs through 2024, will ensure that women can access annual screening mammograms free of cost-sharing, starting at age 40. Last Congress, ASBrS supported bipartisan legislation entitled the PALS Act, which contained an extension of the USPSTF moratorium.
• Graduate Medical Education. The Omnibus funds 200 new residency positions, to be available in 2026. At least half of these new slots are directed to psychiatry or psychiatry subspecialty residencies, but the remainder can be applied to other specialties. The legislation also directs at least 10% of the new positions towards certain types of hospitals: for example, hospitals located in rural parts of the country or hospitals serving areas experiencing a shortage of health professionals. For several years, ASBrS has been actively engaged in the Graduate Medical Education Coalition, to educate Congress about the physician shortage and push for funding for additional residency positions.

Advocacy to address the devaluing of physician services in the Medicare Physician Fee Schedule must continue as we identify long-term solutions that avoid year-end Congressional scrambles to address annual payment cuts. ASBrS continues to work on all fronts to ensure that adequate Medicare reimbursement is paired with safe, high-quality care in the field of breast surgery. We thank all ASBrS members who contacted members of Congress about policies addressed in this legislation and the ASBrS Legislative Committee for its continued efforts to ensure access to quality care for our patients.

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