Medicare payment has been an issue for physicians for decades, and AMA Board of Trustees Chair Willie Underwood III, MD, MSc, MPH, a urologist, has experienced those challenges firsthand.
Dr. Underwood has more than 20 years of overall urologic surgery experience, and during that time, he's watched physicians suffer from the lack of an annual inflationary update in pay. As a result, Medicare physician payment has fallen 26% since 2001 when adjusted for inflation.
"That is simply unacceptable and unsustainable," he said.
That is just one of a number of problems with Medicare physician payment, Dr. Underwood said. He discussed some of the major issues and the AMA's advocacy efforts to fix Medicare in a recent episode of “AMA Update.”
Leading the charge to reform Medicare pay is the first pillar of the AMA Recovery Plan for America’s Physicians.
The AMA has challenged Congress to work on systemic reforms and make Medicare work better for you and your patients. Our work will continue, fighting tirelessly against future cuts—and against all barriers to patient care.
The absence of an annual inflationary update is the most important Medicare payment reform issue, according to Dr. Underwood, but it is not the only problem. Budget neutrality is another concern as federal law requires that if Medicare spending for physicians in one area increases, it must be decreased in a different area so that the overall impact is budget neutral.
Combine that with the Merit-based Incentive Payment System that results in more unexpected payment cuts, as well as the scheduled 3.37% across-the-board 2024 cut from the Centers for Medicare & Medicaid Services (CMS), and it becomes clear that the Medicare payment schedule is on an unsustainable path.
The disheartening aspect of the ongoing situation is not strictly financial. The people who get hurt the most by the current situation are the patients who wind up having reduced access to physician care. In Dr. Underwood's practice, he'd like to have 30–40 minutes per patient to talk about their specific needs, but given the current constraints, he said he's lucky if he's with a patient for more than seven minutes.
"That undermines your ability to provide top-notch care and build relationships with the patients and their families, so that you can optimize and really understand their issues and help them out," he said. "All these things have happened to the detriment of health care delivery and to the detriment of society and to the patients whom we swore to serve."
There are promising developments with Medicare payment reform, starting with H.R. 2474, the Strengthening Medicare for Patients and Providers Act. The bill would tie Medicare physician payment to the Medicare Economic Index.
Meanwhile, a separate proposed measure would reform the budget-neutrality rules and how they affect Medicare physician payments. The proposal, Dr. Underwood noted, is based on work done by the AMA.
Despite the difficulties, Dr. Underwood is optimistic about Medicare payment reform. For changes to take place, though, more voices need to be involved in the conversation, he said.
"Now is not the time to sit back and say: I'm going to expect someone else to solve this problem for me," he said. "We are stronger together. There are 1.2 million physicians in this country, and it's time for our voices as 1.2 million-strong to be heard."
The AMA and nearly 120 state medical associations and national medical specialty societies sent a joint letter to congressional leaders Nov. 16 urging them to cancel the 3.37% cut and fix Medicare’s systemic problems.
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