Oct 26, 2022 - Health

Specialists seek a reprieve for 2023 Medicare payment cuts

Illustration of a gloved hand holding a scalpel over a hundred dollar bill

Illustration: Natalie Peeples/Axios

Radiologists, nuclear medicine specialists and vascular surgeons are bracing to see if they'll take the worst of Medicare physician payment cuts next year.

Why it matters: The Centers for Medicare and Medicaid Services is due to release a final fee schedule as early as this week that's expected to continue phasing in reductions to medical specialties -- and likely prompt appeals to Congress for a year-end reprieve.

Driving the news: A draft fee schedule released in July put most specialties in line for modest cuts. Infectious disease doctors and internists would buck the trend and receive increases of 5% and 3%, respectively.

  • Interventional radiology could see the deepest cuts, with a 4% cut, while radiology, vascular surgery and nuclear medicine could each see 3% reductions.
  • The specialty practices targeted for cuts are also some of the most lucrative.
  • Medicare cuts could drive down other payer rates and lead to access issues, with providers rethinking how they deliver services particularly to rural regions or regions beyond their practices.
  • Such cut backs could lead to delayed care and "wait times for clinical issues that aren't acceptable or shouldn't be," Bob Still, executive director of the Radiology Business Management Association, told Axios.
  • The cuts could come at a time patients are still delaying screenings: Nearly half of women surveyed for the Radiology Patient Action Network this fall indicated they had not had a mammogram in the past three years.
  • The Surgical Care Coalition argues cuts to vascular surgery will jeopardize seniors’ access to critical treatments and procedures.

The physicians' pleas come amid a year-end rush by hospitals, home health agencies and other health providers to head off Medicare payment changes.

  • Lawmakers in a post-election lame duck session will decide what gets wrapped into a year-end spending deal that's likely to also take up disaster relief, Ukraine aid and a host of other non-health issues.

Between the lines: Physicians are the only health provider group not receiving an inflation adjustment to their Medicare payment rates in 2023, and there's a statutory freeze through 2026.

  • Those practicing in independent or small practices say the cuts, combined with inflation and staffing pressures, could be economically ruinous and prompt more mergers and buyouts.
  • "The discrepancy between what it costs to run a physician practice and actual payment, combined with the administrative and financial burden of participating in Medicare, is incentivizing market consolidation," provider groups wrote in a September letter to congressional leadership.
  • The fear is that other payers that index rates of off Medicare rates could follow the agency's lead going forward, Sterling Ransone, president of the American Academy of Family Physicians, told Axios.

Yes, but: The Medicare Payment Advisory Commission has argued that payments to doctors are adequate.

While clinicians experienced pandemic-related hits on revenue and volume, Congress bailed them out with billions of dollars in relief, business should rebound by 2023, the advisers say.

What we're watching: A relief bill from Rep. Ami Bera (D-Calif.) would delay the physician payment cuts a year. Ransone said the family physicians group also wants to see a longer-term fix.

  • Separately, a bipartisan group of lawmakers has announced plans to work on longer term physician payment reforms.
  • Absent a fix, Ransone said providers in smaller practices might begin to limit patient volume or services based on their bottom line.
  • "To keep our doors open, we have to balance books," Ransone said, which could mean potentially seeing less Medicaid, Medicare or Tricare patients in order to make up revenue from commercially-insured patients, he added.
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