Contributor: To Protect Patient Access, Congress Must Block Medicare Physician Payment Cuts

The final 2023 Medicare Physician Fee Schedule recently announced by CMS includes a roughly 4.5% cut to physician payments. This would not only undermine physician practices nationwide but also threaten access to timely care for Medicare beneficiaries.

This nearly 4.5% across-the-board reduction in Medicare physician payments is all but certain to go into effect on January 1, 2023––unless Congress acts swiftly. Unfortunately, this is just the latest in a long line of policy missteps that has led to a 2-decade-long downward spiral for Medicare physician payments. According to an analysis of Medicare Trustees data by the American Medical Association, payments to physicians through Medicare declined by 22% from 2001 to 2021, when adjusted for inflation. This is not sustainable for anyone, much less the medical professionals who patients rely on for everything from cancer care to physical therapy.

Part of the reason the situation has gotten so bad is that physicians are the only type of Medicare providers who do not automatically receive an annual inflationary update. All other providers—including inpatient and outpatient hospitals, nursing centers, and hospices—will see upwards payment adjustments in 2023, just like they do every year. Meanwhile, physicians working with Medicare will see no such adjustments until 2026 due to an ongoing statutory freeze implemented by Congress. The big raise then? A paltry 0.25%.

At the same time, the economic impact of the COVID-19 pandemic and soaring inflation rates have taken their toll on America’s physicians. Many smaller, independent physician practices are struggling to keep their doors open in order to continue providing the same level of care for their patients, particularly physicians that work with the Medicare system, which already reimburses them at much lower rates than other payers like private insurance.

If physicians are forced to endure yet another reduction in Medicare payments, the brunt of the impact will fall squarely on patients who rely on Medicare to cover the treatments and services they need to stay healthy and active. As a result of these new cuts, many physicians may be forced into consolidation or bankruptcy.

Either way, millions of vulnerable patients who already face urgent health care needs, including high rates of chronic health conditions, will end up struggling with reduced access to care, fewer services, and longer wait times. Some physicians may even be forced to refuse low-reimbursement payers like Medicare and Medicaid and scale back their charitable care services, threatening some of our nation’s most at-risk patient groups and undermining the health and well-being of entire communities.

If the situation seems dire, that’s because it is. Fortunately, there are leaders in Congress who recognize the existential threat to patient access that these Medicare physician payment cuts represent and have put forward thoughtful legislation to at least begin addressing the issue. Two physician members, Representatives Ami Bera, MD, D-California, and Larry Bucshon, MD, R-Indiana, have introduced the Supporting Medicare Providers Act, HR 8800, which would prevent the harmful cut in the Medicare Physician Fee Schedule from going into effect for at least 12 months.

While the legislation won’t solve everything that’s wrong with the Medicare physician payment system, it would at least give some temporary relief to physicians—and in the process, preserve patient access to care—while enabling lawmakers and CMS to come up with a long-term fix.

Throughout the COVID-19 pandemic, patients turned to their physicians as sources of care, comfort, and support—and physicians rose to the challenge. Slashing Medicare payments to physicians now would not only be a slap in the face, it also would create new, and, in some cases insurmountable, access barriers for Medicare beneficiaries and patients nationwide.

As cofounder and now CEO of Patients Rising, I’m calling on our elected officials in Washington, D.C., to help avoid a potential catastrophe by passing the Supporting Medicare Providers Act. There is little time left to ensure millions of patients are not left in the lurch by these proposed cuts to Medicare physician payments.

Congress must act swiftly and decisively.

Terry Wilcox is the cofounder and CEO of Patients Rising, a patient organization that provides programs and services ranging from education, navigation, and self-advocacy to policy solutions.