By Nate Birt
An effective 8.5% cut in Medicare payments to doctors could curb senior Americans’ access to procedures such as cataract surgery, doctors and other medical experts say. It could also force physicians to choose between hiring trained staff or purchasing expensive equipment, and eventually, surgical facilities could close.
Doctors’ groups have asked Congress to pass the Supporting Medicare Providers Act of 2022 (H.R. 8800), which would close approximately half the anticipated funding gap.
“Physicians are paid for services based on the Medicare Physician Fee Schedule (MPFS) released annually by the Centers for Medicare & Medicaid Services (CMS),” explains Christian Shalgian, director of the division of advocacy and health policy, American College of Surgeons, in an interview with DealFlow’s Healthcare Services Investment News. “Since 2020, the MPFS has cut the Medicare conversion factor, the figure used to determine the Medicare payment to a physician. … Medicare’s conversion factors have failed to keep up with inflation and are roughly 50 percent of what they would be if they kept pace with inflation. Coupled with the increasing costs of health care and general inflation, failing to update physician payments jeopardizes patient access to care.”
The combined 8.5% cut would come from two places:
- 4% Medicare cut required under the federal Pay-As-You-Go (PAYGO) rule, which is intended to avoid boosting the federal deficit or cutting into the nation’s financial surplus
- 4.5% anticipated cut for surgeons and anesthesiologists that CMS approved for implementation Jan. 1, 2023
“These cuts could further make it difficult for surgeons to keep their surgical practices open, limiting the number of Medicare beneficiaries who can receive critical treatments and procedures,” Shalgian says. “These physicians will then have to make hard decisions about whether to hire healthcare personnel such as nurses and other staff, or fund necessary equipment to perform needed procedures, ultimately affecting the quality of care patients receive.”
Doctors ask Congress to take action
The bill in question, H.R. 8800, would extend payments for specified physician services through 2023, avoiding the planned 4.5% cut. Introduced by U.S. Reps. Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.), both doctors, the legislation has been under review by two House committees, Energy and Commerce plus Ways and Means, since Sept. 13.
Over the course of three weeks, DealFlow placed calls and sent emails to legislators’ media relations staff requesting comment from members of the Health Subcommittee, part of Ways and Means. They included Chair Lloyd Doggett (D-Texas), Ranking Member Rep. Vern Buchanan (R-Fla.), Rep. Terri Sewell (D-Ala.) and Rep. Mike Thompson (D-Calif.) None were returned.
A spokesperson for the American Medical Association referred DealFlow to the organization’s Nov. 1 statement.
“The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians,” noted Jack Resneck Jr., a doctor and president of the association, in the statement. “The AMA will continue working with Congress to prevent this harmful outcome.”
Further pressuring Congress to act is a group of more than a dozen medical associations called the Surgical Care Coalition. Launched in spring 2020, the group spans neurology, ophthalmology, vascular care and more.
“Congress should not allow politics to come in the way of protecting seniors from losing access to critical surgical care,” said Michael Champeau, a doctor and president of the American Society of Anesthesiologists, in a statement. “Anesthesiologists stand with the surgical care community and over one million physicians and other health care professionals who support H.R. 8800 and the broader work that must be done to reform our healthcare system.”
Other doctors pointed to the direct impact failure to curb the cuts could have on especially vulnerable patients.
“H.R. 8800 would provide invaluable support to patients in need of life-saving surgeries that remove and substantially reduce the risk of breast cancer,” said Nathalie Johnson, a doctor and president of the American Society of Breast Surgeons. “As breast cancer rates continue to rise, impacting millions of women each year, preventing the cuts scheduled to take effect in the new year through H.R. 8800 is vital to help breast surgeons continue to provide women with the care they need.”
“Millions of beneficiaries depend on Medicare to access sight-saving and sight-restoring procedures that are critical to improving their livelihoods and quality of life,” added Douglas Rhee, a doctor and president of the American Society of Cataract and Refractive Surgery. “Further cuts to reimbursement are unsustainable. Congress must act now to stop the cuts to ensure seniors continue to have access to medically necessary procedures.”
Senators call for swift action before end-of-year deadline
Doctors aren’t alone in calling for changes—and quickly. In a Nov. 2 letter to U.S. Senate leadership, U.S. Sen. Debbie Stabenow (D-Mich.) and dozens of other senators requested action to avert potential damaging cuts.
“Failure to act in the coming weeks could result in reduced staffing levels and office closures, jeopardizing patient access to care,” Stabenow and her colleagues wrote. “We are especially concerned about this impact in rural and underserved communities. Failure to act on longer-term reforms will undermine Medicare’s ability to deliver on its promises to future seniors and generations.”
As days dwindle, doctors push for reform or consider more extreme options
Shalgian, with the American College of Surgeons, notes his colleagues supported this letter. Their coalition group also has launched a full-court press to get changes enacted.
“We have also amped up our grassroots efforts to include phone calls, letters and visits to congressional offices, prioritizing our efforts with staff in congressional leadership offices as well as relevant committees of jurisdiction,” Shalgian explains. “This is all part of a broader annual campaign leveraging earned media, social media, and creative assets such as surgeon and patient stories via opinion-editorials and direct-to-camera films, and mobilizing our surgeons to advocate to protect their patients and stop the cuts.”
On Twitter, some are floating more extreme approaches, such as leaving Medicare entirely.
“We are seriously considering no longer participating in the Medicare program with the looming cuts in Jan.,” wrote Robert Berry, a Texas orthopedic surgeon, on Nov. 16. “How many of my colleagues will do the same? At some point it doesn’t make financial sense to continue. It’s just math.”
