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It's time to talk about docs' payment cuts, again

Illustration of a doctor in a white coat and scrubs standing at the end of a cliff formed by a large one hundred dollar bill which is laid flat then descends downward abruptly like a waterfall

Illustration: Annelise Capossela/Axios

Doctors are ramping up pressure on Congress to use the next government funding package to reverse cuts to their Medicare payments that took effect on Jan. 1.

Why it matters: Congress is still stuck in an annual dance of being pressured to increase physician payments, even after the 2015 remedy that put an end to the perennial "doc fix."

  • This time, doctors are raising alarms about a 3.37% cut in physician reimbursements — this one stemming from a CMS 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."

  • "We see the expiring continuing resolution on January 19 as the deadline for also addressing the Medicare physician payment cuts that went into effect January 1," he said.

Yes, but: Josh Gordon, director of health policy for the Committee for a Responsible Federal Budget, said the sky is not falling, but that it's reasonable to make reforms to avoid the game of annual payment updates if the changes are paid for.

  • "Medicare beneficiaries still have very good access to physicians under the current trajectory of the fee schedule," he said.
  • "The bigger issue is this continuous annual game, which was supposed to have ended in 2015, when we got rid of the [Sustainable Growth Rate] and regular doc fixes, and it seems like we're kind of back in that world again," he said. "So it's probably time for Congress to do a more long term reform."
  • Moving to site neutral payments for hospitals would be a way to generate savings that could in part be used for changing doctor payments, he said.

Driving the news: Sources expect Congress to deliver some partial relief from the most recent cuts.

  • Doctors are often well-connected in their communities and members hear from them when they go back home, keeping the issue prominent on Congress's radar.
  • The Senate Finance Committee, for example, approved as part of a larger November package a measure to reduce the cut from 3.37% to just over 2%.
  • CBO estimated that partial relief as costing $670 million over 10 years, far from an insurmountable amount to pay for, especially because money in the Medicare Improvement Fund can be used.

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

  • That measure would provide for annual payment increases for doctors tied to inflation.
  • What still can get done by Jan. 19 is unclear, though, amid broader uncertainty around government funding.
  • "We're not going to have wholesale reform by January 19, we know that, 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," Ehrenfeld said.
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