Doctors debate how Medicare payment cuts will affect aged care

[UPDATED at 11 a.m. ET for news developments.]

Doctors are calling on Congress to cancel the cuts scheduled to take effect January 1 on reimbursements they receive from Medicare.

In what has become a near-annual ritual, groups of doctors are arguing that patients will have a harder time finding doctors who accept Medicare if lawmakers allow pay cuts to happen. go out.

A draft more than 4,000-page government spending bill released by lawmakers early Tuesday morning proposed much smaller than planned cuts to Medicare payments. But the bill, which Congress hopes to pass by the end of the week to maintain government funding and prevent the shutdown, will not go as far as doctors would like.

“Despite overwhelming bipartisan, bipartisan support to prevent a full cut in Medicare doctor payments, Congress has once again failed to end the cycle of Medicare cuts. harmful, shows a disregard for vulnerable seniors,” the Alliance for Surgical Care, an organization representing surgeons and anesthesiologists, said in a statement. .

The doctors’ lobbying campaign gained traction on Capitol Hill. A bipartisan group of 115 House lawmakers gather behind the doctors in a letter to congressional leaders and President Joe Biden last week, urging them to block cuts that they say will “only make the situation much worse” for Medicare patients.

In recent years, the Centers for Medicare & Medicaid Services has planned pay cuts to offset the cost of increased payments for low-paid services, like primary care. Doctors could also see cuts tied to widespread cuts made by Congress in recent decades to try to keep government spending in check.

Some Republicans have been trying to wait for the spending package to pass until their party takes control of the House next year and could have a bigger say in what they call out-of-control spending. A Republican priority in the upcoming House of Representatives is to limit Social Security and Medicare, a federal health insurance program for people age 65 and older, among others.

Senator Ron Johnson of Wisconsin, a Republican on the Senate Budget Committee, told reporters: “We are mortgaging our children’s future. “This is killing us from a financial standpoint. It has to stop.”

Despite concerns about bloated government spending, for years doctors have been successful in delaying or mitigating proposed pay cuts, arguing that there will be dire consequences if the cuts start.

Doctors have a lot of political influence in Washington. The American Medical Association, the professional organization that represents and lobbies on behalf of physicians, has spent more than $460 million on lobbying since 1998, more than most organizations. is different. The New Yorker reported this year.

Since the early 2000s, Congress has voted every year or two to delay or reverse plans to reduce Medicare payments to doctors. In 2015, Congress ended a measure that would cut payments by 21%. Last year, Congress lost 3%.

If Congress can’t pass the spending bill, doctors will face a 4.5 percent cut in Medicare fees. Under the draft bill released Tuesday, they will instead see a 2% cut starting January 1. Other cuts – including a 4% cut under congressional budget rules in order to balance spending and expiration of the payment program offering 5% bonus – will be further delayed or reduced.

As in previous years, doctors have waged a massive campaign to convince Congress that reducing the amount it pays to care for Medicare patients will discourage many doctors from accepting them as patients.

Earlier this month, the American Medical Association sent a letter to congressional leaders signed by all 50 medical associations in the state, as well as that of the District of Columbia, argued that the pay cuts would hurt doctors and patients.

“The burnout, stress, workload and cumulative impact of COVID-19 are causing one in five doctors to consider leaving their current job within two years,” the letter read. “Cutting down payments will only accelerate this unsustainable trend and will inevitably lead to Medicare patients struggling to access health care.”

According to the American Medical Associationthe cost of running a medical facility rose 39% from 2001 to 2021, but Medicare payments to doctors, adjusted for inflation, fell 20% over that period.

“It’s more expensive to run our businesses than it used to be,” said Dr. Loralie Ma, a radiologist in suburban Baltimore. , from bandages and surgical tubes to salaries for office workers. “It’s very difficult, and when Medicare does something like this, it reduces accessibility, especially for the elderly.”

“There are patients who can’t find a doctor. They’re using Medicare and the doctors aren’t accepting new Medicare patients,” said Dr. Donaldo Hernandez, a Santa Cruz, California-based physician who is president of the California Medical Association.

It is difficult to “break even” when caring for Medicare patients at current government rates, he said. “It just doesn’t make economic sense.”

A body that advises Congress on Medicare issues has expressed concern about some Medicare payments for primary care and has reported that, between 2015 and 2020, the number of primary care physicians primary care for Medicare beneficiaries fell from 2.8 to 2.4 per 1,000 beneficiaries.

According to the Medicare Payments Advisory Committee (MedPAC), about 3% of Medicare beneficiaries surveyed in 2021 said they had looked for a new primary care provider in the previous year and had difficulty finding one. search.

However, looking at a broader picture based on data from 2019 to 2021, “access to clinician services for Medicare beneficiaries appears to be stable and comparable to ( or better) for privately insured individuals,” MedPAC President Michael Chernew said in a letter dated October 28 to members of Congress.

Gerard Anderson, a professor of health policy and management at Johns Hopkins University, said doctors’ opposition to scheduled pay cuts has a familiar ringing tone.

“For 40 years, I have heard providers argue that they will stop doing business or not take on Medicare patients if… the cuts go through,” Anderson said. “Medicare patients still see their doctors, hospitals, and other providers 40 years on.”

For most doctors, Medicare payments make up only a small portion of their business, Anderson adds. The rest could include payments from Medicare Advantage health plans, which have their own payment systems, and private insurers, he said.

Senator Debbie Stabenow of Michigan, a top Democrat in the Senate, and Senator John Barrasso of Wyoming, a top Republican in the Senate, in November wrote a letter signed by a bipartisan group of 44 other senators in November calling on party leaders to avert impending cuts.

“We would love to have a health package that would stop the cuts and make some of the other policy changes we need. Still don’t agree, but I’d love to see it happen,” Stabenow said in an interview with KHN on December 15.

When asked if she was optimistic, she said, “I think we have a fair chance.”

KHN Washington editor and reporter David Hilzenrath contributed to this report.


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