In 2001, ophthalmologist Ravi D. Goel, MD, joined a practice in Cherry Hill, New Jersey, the town in which he grew up.
He loves his hometown and worries about whether he will financially be able to keep caring for people in his community he has called home for 50 years.
Dr. Goel is part of a two-person physician group and about 40% of the patients that he and his partner see have Medicare.
When adjusted for inflation, Dr. Goel today receives 33% less payment from Medicare (PDF) for providing care to those patients than when he began practicing in 2001, AMA data shows.
His practice is a small business and Medicare payment cuts combined with no adjustments for inflation annually hurt the chances of his business—the place in his community for patients to receive needed medical care—surviving, let alone being able to grow to take care of more patients in the community.
If payment to physicians doesn’t change, “ultimately, in my case, patients will suffer vision loss with delays in care. And more generally, delays in care harm patients throughout the medical system,” Dr. Goel said when the AMA asked physicians on the front lines to share their personal stories of how Medicare cuts are impacting 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.
“My mission is to protect sight and to move medicine forward,” Dr. Goel said. “Every patient deserves to be able to see a physician in their community in small practices, in practices in which they are valued and they are seen as patients, not as numbers. Medicare can help physicians in communities continue to deliver care on an individual basis … to do that we need inflationary updates and we need fair payment for the services that we deliver.”
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.
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 strongly supports the legislation, which at this article’s deadline had over 70 co-sponsors, and will work with members to include it in upcoming legislation to fund the federal government beyond the March 14 statutory deadline.
The AMA is leading the charge to reform the Medicare payment system.
All specialties, all patients at risk
No matter what type of medicine a physician practices, cuts to Medicare payment diminish physicians’ ability to care for patients.
Amish Dave, MD, is a rheumatologist in Seattle. He is one of about 40 physicians in his specialty in the state who takes care of adult patients battling autoimmune diseases.
“Every time that Medicare is cut, we start to lose a rheumatologist, which means it’s harder and harder for patients to get access to care, to take care of their autoimmune diseases, whether it’s rheumatoid arthritis, lupus, vasculitis or another condition that’s really affecting their quality of life,” he said. “Every time that there’s a cut to Medicare, it means that it’s harder for practices to stay afloat and that means it’s harder for every single patient to see a physician.”
And when physicians leave or practices close, patients of every age suffer, not just older adults, Dr. Dave said.
“It’s important for physicians to be paid fairly so they can keep their offices afloat because, ultimately, we went into medicine to take care of patients and not worry that we’re not going to be able to stay afloat.”
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Even emergency care threatened
The federal Emergency Medical Treatment & Labor Act (EMTALA) requires that emergency departments treat everyone who walks through the door, no matter the ability to pay. And as physicians leave practice early or close their practice entirely, some patients are going to the emergency department for care they otherwise could have received in another setting.
Yet Medicare cuts have meant less money this area of medicine that has become a safety net for some American patients. The result: When Portland, Oregon, emergency physician John C. Moorhead, MD, walks into work there can be 40 to 50 patients waiting for an inpatient bed.
“It results in patients waiting to get appropriate services as inpatients and other patients waiting in the emergency department where we should be dealing with acute situations and are oftentimes required to go on divert and send patients to other facilities,” he said, noting that type of work environment “really causes confusion for patients and really poor outcomes.”
It’s a problem that’s been brewing for 20 years, Dr. Moorhead said, and it’s reached a crisis level.
“Patients know it and doctors know it. Let’s work together to find a fix,” he said.
Take action now
M. Laurin Council, MD, a dermatologist outside of St. Louis, also sees the same access to care concerns across specialties in her state, noting that the Medicare rate impacts the entire health care system because that rate affects what private insurance carriers are willing to pay physicians as well.
She said it’s important to let Congress know that reduced Medicare pay is causing practices to close.
“Physicians need to tell their legislators. Patients need to tell their legislators,” Dr. Council said. “We just need to make sure that people are aware that if Medicare reimbursements decline, it affects patients and their access to care.”
Palm Beach Gardens, Florida, ophthalmologist Joseph Nezgoda Jr., MD, added that lawmakers need to know that not fixing the physician Medicare payment system hurts the entire community—from the staff he is employing to the patients for which he cares.
“There are many items in the federal budget that need to be looked at, but in the end we’re helping people,” Dr. Nezgoda said. Medicare “is the mechanism by which our nation’s physicians—some of the best health care in the world—can reach out, fix our population, heal our patients and our communities.”
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. 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.
The AMA’s Medicare Basics series, provides an in-depth look at important aspects of the Medicare physician payment system.
