Congressional action is needed—now—on Medicare payment reform

Jesse M. Ehrenfeld, MD, MPH , Immediate Past President

AMA News Wire

Congressional action is needed—now—on Medicare payment reform

Nov 29, 2023

Our nation’s physicians are speaking with one voice in sending a resoundingly clear message to Congress: The 3.37% Medicare payment cut set for Jan. 1, 2024, is a dire threat to both patient well-being and physician practice viability—and legislation to stop it must be passed.

Coupled with soaring practice costs and other inflationary pressures, yet another round of Medicare payment cuts is an exceedingly bitter pill for physicians to swallow. The broken Medicare payment system, which the AMA has been campaigning to reform for years, is progressing toward a full-blown crisis. The failure to correct the dangerously unsustainable path Medicare continues to follow jeopardizes access to affordable care for tens of millions of our nation’s most vulnerable patients, including older adults and people with disabilities.

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Nearly 120 health care organizations recently joined the American Medical Association in a letter (PDF) to congressional leaders urging them to fix the flawed Medicare payment system. Our seniors and the physicians who care for them are counting on Congress to prevent these cuts. The sense of urgency that surrounds this crisis is all too real for patients and physicians alike, as it should be for lawmakers on both sides of the aisle in Washington, D.C. The AMA continues to do all we can to elevate this dire situation to the top of the congressional agenda.

Access to care is placed at tremendous risk when financially strained physician practices reduce their hours, lose the ability to take on new Medicare patients, or shut down entirely. The risk is greatest in rural communities, where a single physician practice can represent the only access point to health care for dozens or even hundreds of miles. The impact is felt in many urban areas as well, typically through unacceptably long wait times that patients must endure to access care.

This is the situation my parents faced at their home in Jacksonville, Florida. They are in their 70s and, like many their age, they suffer from a variety of age-related ailments, from chronic disease to mobility limitations. They require complex care and need to see a number of specialists. They relied on a trusted and longtime primary care physician to coordinate their team. That is until their primary care physician stopped seeing Medicare patients.

We are all familiar with the reasons why physicians stop seeing Medicare patients and they typically come down to one thing—an inadequate payment rate that, if you’re in private practice, makes it tougher and tougher to keep the lights on.

Too many older adults, like my parents, have gotten the same letter notifying them that their doctor was no longer able to see Medicare patients. This usually leads to a frustrating and frantic search for a replacement and too often causes harm, as delays occur, things get missed in the transition, and patients often end up having to travel farther to receive necessary services.

Sadly, this is playing out all over America as more than 100 million Americans lack regular access to a primary care physician, a number that has nearly doubled over the last decade.

The simple fact Medicare physician payment rates plunged by 26% (adjusted for inflation) between 2001 and 2023 highlights the need to not only block another round of devastating cuts, but to place this badly broken system back on track toward sustainability,

Restructuring Medicare physician payment to ensure financial stability and predictability, while simultaneously safeguarding patient access to high-quality care, is one of the five pillars of the AMA Recovery Plan for America’s Physicians. The other four are fixing prior authorization, stopping inappropriate scope of practice expansions by nonphysicians, continuing coverage of coordinated telehealth, and addressing the stigma of physician burnout and prioritizing good mental health.

It is time for our nation to support physicians everywhere and help us accomplish drew us all to medicine in the first place: providing the best possible patient care.

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I’m at a loss as to why the Medicare physician payment system lacks an inflation-based annual update. This stands in stark contrast to the routine, automatic, yearly increases given to hospitals, skilled nursing facilities and others who bill Medicare.

The AMA strongly supports a measure now pending in Congress, the Strengthening Medicare for Patients and Providers Act (H.R. 2474), that would address this flaw by tying the Medicare physician payment schedule to the Medicare Economic Index.

Doing so would place physician practices on an equal fiscal footing with virtually every other health care organization and professional paid by Medicare, including hospitals and skilled nursing centers. Physicians deserve the same consideration. This measure is a key step toward the long-overdue reform of the badly outdated Medicare payment system. Predictability is a key element of this reform. Physicians need and deserve automatic, positive payment updates tied to increased practice costs they can rely upon.

Physicians put patients first. It is time for our political leaders to prioritize our nation’s physician workforce by correcting a Medicare system that penalizes doctors for their service to us all.