Jan 10, 2024 - Health

Congress faces pressure to reverse doctors' payment cuts — again

A person in a doctor's coat standing on a $100 bill that's actually a cliff.

Illustration: Annelise Capossela/Axios

Congress is once again being urged to reverse a cut to physicians' Medicare payments, prompting calls for a broader overhaul of how the program reimburses doctors.

Why it matters: Congress is still stuck in an annual dance of being pressured to increase physician payments, even after Washington nearly a decade ago put an end to the despised "doc fix" that forced lawmakers to regularly forestall deep cuts.

Driving the news: With the Jan. 19 government funding deadline approaching, doctors are ramping up pressure on Congress to use the next spending package to reverse cuts that took effect Jan. 1.

  • This time, they are raising alarms about a 3.4% cut in physician reimbursements stemming from Medicare's plan to adjust a key metric governing physician pay, known as the conversion factor, and a new billing code for complex office visits.
  • Doctors argue it will particularly harm rural physicians who work on thinner margins, and that it compounds previous reimbursement cuts.

What they're saying: American Medical Association president Jesse Ehrenfeld told Axios the cuts are "placing enormous pressure on physicians."

Yes, but: Josh Gordon, director of health policy for the Committee for a Responsible Federal Budget, argues that doctors' complaints are overblown, and that the cuts won't undermine care for seniors and people with disabilities enrolled in Medicare.

  • "Medicare beneficiaries still have very good access to physicians under the current trajectory" for physician pay, he said.
  • The bigger issue, he said, is that Washington appears to be back in the annual cycle of Medicare cutting physician pay, only for Congress to step in again, making a long-term fix reasonable if it is paid for.
  • At the end of 2022, Congress also partially reversed Medicare cuts to doctors, though the industry at the time argued it was not enough.
  • "It's probably time for Congress to do a more long-term reform," Gordon said.

Zoom in: It took lawmakers years to agree on how to eliminate the flawed Medicare payment formula behind the doc fix.

  • Any bigger reform to the current Medicare payment formula, which is based on a complex set of factors, likely wouldn't be nearly as pricey — the 2015 reform cost $214 billion.
  • But the politics of reforming physician pay is tricky, and policymakers have to balance concerns about the sustainability of Medicare's finances while ensuring the program is attractive enough to providers.
  • Doctors are often well-connected in their communities, and lawmakers hear from them when they go back home, keeping the issue prominent on Congress's radar.
  • Lobbyists told Axios they expect Congress will deliver some partial relief from the most recent cuts.
  • The Senate Finance Committee, for example, approved as part of a larger November package a measure to reduce the cut from 3.4% to just over 2%. The Congressional Budget Office estimated that would cost $670 million over 10 years — not a prohibitive price tag.

What's next: The AMA is touting a bipartisan bill from a group of lawmakers who are doctors: Republican Reps. Larry Bucshon of Indiana and Mariannette Miller-Meeks of Iowa, and California Democratic Reps. Raul Ruiz and Ami Bera.

  • Their measure would provide for annual increases for doctors tied to inflation, but it's unlikely Congress will agree on a more comprehensive payment change like this one before the fast-approaching government funding deadline.
  • "We're not going to have wholesale reform by January 19, we know that," AMA's Ehrenfeld said.
  • "But it's a goal that we still hold to, because we've got to get off this hamster wheel of these short-term fixes every single year."

A version of this story was published first on Axios Pro. Unlock more news like this by talking to our sales team.

Go deeper