Feb 15, 2023 - Health

Doctors prod Congress to do more on Medicare pay

Illustration of a gloved hand with tweezers holding a $100 bill.

Illustration: Gabriella Turrisi/Axios

Top doctors groups are pressing Congress to overhaul the way Medicare pays physicians just as lawmakers are getting pulled into the politically charged debate over possible cuts to entitlement programs.

Why it matters: The new appeals serve notice that there's political risk if provider cuts become part of conservative-led efforts to balance the federal budget or a deal on raising the debt limit.

Driving the news: The American Medical Association and nearly 100 other physician groups recently called for "long-term, substantive payment reforms," saying Medicare payments to clinicians have declined 22% from 2001 to 2021, when adjusted for inflation.

  • The doctors want an inflation adjustment built into their rates, to help ensure they can make enough treating Medicare patients while costs rise.
  • "Our payroll has gone up 20% in the last year," said Bobby Mukkamala, a head and neck surgeon and immediate past president of the AMA Board of Trustees.
  • Physician groups say the burden is especially hard for independent practices struggling with year-to-year cuts.
  • "I have heard from a few people who have said this may push them into early retirement or changing to a nonclinical career or potentially selling their practice," Tochi Iroku-Malize, president of the American Academy of Family Physicians, told Axios.

Yes, but: The pleas come at a politically loaded moment, with Medicare emerging as a 2024 campaign issue and both parties vowing to save the program.

  • As Axios' Caitlin Owens reported, there are plenty of reforms that would reduce Medicare spending and shore up the program's solvency not by cutting seniors' benefits, but through reductions to fees paid to health industry groups.
  • Republicans' relationship with the AMA has also soured over the group's positions on issues like abortion and gender-affirming care, Caitlin and Victoria Knight recently wrote.

Reality check: Doctors still have substantial clout with Congress.

  • They won a partial reprieve in the year-end spending package, with a rollback of scheduled cuts to the Medicare physician fee schedule that doctors groups had portrayed as economically ruinous.
  • The surprise billing law also established an arbitration process to settle billing disputes with insurers, though some physician groups are suing to challenge the way the Biden administration is implementing the process.
  • In past sessions, clinicians received bipartisan support from physician-lawmakers in Congress.
  • "Physician payment is not a new problem, but is one that should be addressed this Congress," said Rep. Michael Burgess (R-Texas), a senior member of the House Energy and Commerce Committee. "It is important that we put forward policies that will encourage more physicians to keep or take more Medicare patients rather than the trend of physicians not being able to provide them care."

Between the lines: Provider groups have warned that without more funding, some clinicians will be forced to sell their practices to health systems or private equity firms.

  • "More than 50% of physicians don't own their own practices, and that's a trend that given the way things are going, I don't see that changing any time soon," Mukkamala said.
  • Medicare advisers to Congress also recently recommended that lawmakers increase physician payments in 2024, to offset rising costs.

Our thought bubble: Increasing payments involves new Medicare spending, which will be a particularly difficult ask in the current political environment, and with Medicare's benchmark trust fund expected to reach insolvency in 2028. It remains to be seen if belt-tightening will negatively impact patients, as some industry groups contend.

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