Editor’s note: A short-term funding bill was unveiled after this article’s deadline to keep the government funded through September. AMA President Bruce A. Scott, MD, said in a statement that “physicians across the country are outraged that Congress’s proposed spending package locks in a devastating fifth consecutive year of Medicare cuts, threatening access to care for 66 million Medicare patients.”
Portland, Oregon, internist Marianne Parshley, MD, had a staff member who would finish her day job at the clinic and in the evening drive for Uber Eats so that she could earn enough money to pay her rent.
With today’s Medicare payments to physicians being 33% less (PDF) than they were in 2001 when adjusted for inflation, the money just isn’t there to recruit and retain skilled staff members.
Physicians on Jan. 1 saw a 2.83% pay cut for the services they provide their Medicare patients, the fifth consecutive year of Medicare pay cuts for physicians. And that pay cut comes on top of the Centers for Medicare & Medicaid Services (CMS) projecting a 3.5% rise in the Medicare Economic Index, which measures the cost of running a medical practice.
The economic pressures have forced some physician practices across the country to close in recent years. Those that stay open are forced to make hard choices to stay afloat financially and continue seeing patients.
Those choices have an impact on how physician practices are able to care for their patients.
In Dr. Parshley’s practice, it has sometimes meant seeing staffers they have spent the time and money training leave to take another job. That means the physician must pick up the work that no one else is there to do—often administrative work that adds little to the actual care of patients and contributes to physician burnout.
“Two years ago, during a tough month, we lost six staff members. We worked the next couple of months with everyone doing double, triple duty. One very busy week, I roomed and discharged my own patients without a medical assistant. Telephone calls had to wait for the evening. Even now, our medical assistants are often covering two or three physicians during a day. This slows us all down and decreases access,” said Dr. Parshley, who was among the AMA member physicians who stepped forth to share their personal stories from the front lines on how Medicare cuts are affecting them and their patients. Dozens of physicians were interviewed and the AMA is sharing some of their stories to show the real people behind the numbers who are being hurt.
Dr. Parshley said that if her practice could fully staff itself the way it did 10 or 15 years ago, physicians would be able to care for more patients, easing the challenge of decreasing access to primary and specialty care across the country.
“We had a fully-staffed primary care, five-star patient-centered medical home and it was better,” Dr. Parshley said. “Now, increasingly, I’m doing work that is not at the top of my license in order to cover for the fact that we don’t have staff.”
Congress must act
Congress has a chance to reverse the Jan. 1 cut in mid-March, which is the deadline for the 119th Congress to fund the federal government through the end of the fiscal year. At the end of 2024, the 118th Congress passed a scaled-back continuing resolution to keep the government running and language that would have stopped the physician Medicare payment cut was removed from the bill.
A bipartisan group of 10 House members introduced a bill in late January that aims to stop the 2.83% cut, while providing a 2% payment update. The AMA is leading the charge to reform the Medicare payment system and strongly supports the legislation, which is gaining momentum and at this article’s deadline had over 100 co-sponsors. The AMA will work with members to include it in upcoming legislation to fund the federal government beyond the March 14 statutory deadline.
Without change, more and more practices will be forced to take more drastic measures than just cut back.
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Practices shuttering their doors
Cutting staff as a way to weather pay cut after pay cut can only be sustained for so long.
Louisville, Kentucky, internist Monalisa M. Tailor, MD, has seen primary care physicians in the Bluegrass State become unable to keep their practice doors open because they just don’t have enough income to pay a staff.
“A lot of people in my community have actually left clinical practice because of Medicare cuts,” said Dr. Tailor, who works in a large health system. “As more physicians have to go out of practice and they are no longer practicing clinical medicine, we have a larger pool of patients that are waiting to find a new provider. That is why the current wait to see me is a year.”
In South Dakota, Medicare cuts jeopardize physician practices as well as small community hospitals.
General surgeon Robert Summerer, DO, works at a small, independent community hospital in Madison, South Dakota, and knows that it operates on a very small margin. When Medicare physician pay cuts come, the consequences are unavoidable.
“We don’t just lose the physicians. We lose the ER. We lose the ability to maintain OB care and so many other services,” Dr. Summerer said. “Congress needs to make some changes in how physicians are paid and recognize the fact that it’s just not just about the practice of independent physicians and their salaries.”
Call Congress today
Physicians can make a difference by taking part in the AMA’s Fix Medicare Now campaign, which in 2024 generated more than half a million messages to Congress. Contact your members of Congress today and urge them to include the Medicare Patient Access and Practice Stabilization Act (H.R. 879) in the next spending package. The campaign also lets physicians copy or customize ready-to-use messages to use in social media posts and asks physicians to share their stories about why Medicare payment reform is important.
Unlike hospitals, nursing homes and many others who provide services to Medicare patients, physicians do not get an annual payment adjustment based on inflation, Dr. Tailor said, explaining that “we really need to make an adjustment to that because we need our physicians. They are the health care providers who help guide the team and help come up with a plan to take care of our growing population.”
The AMA’s Medicare Basics series, provides an in-depth look at important aspects of the Medicare physician payment system.
