Congress Fails Again: Physicians to Face 1.68% Medicare Payment Cuts in 2024
As Congress prepares to pass legislation that reverses only half of the 3.37% Medicare physician payment cut implemented on January 1, 2024, the ACCMA and CMA are exasperated that for the fourth straight year physicians will face a payment cut. While the cut is 1.68%, coupled with medical inflation, physicians will experience a devastating 6% cut in 2024. Adjusted for inflation, physicians have experienced a 30% decline in payment since 2001, while other Medicare providers received 60% increases during the same time period. According to a CMA physician survey, two-thirds of physicians said Medicare payments do not cover their costs to provide care, with the result that nearly half are planning to retire early, and 70% are limiting the number of Medicare patients they can treat. In many California communities, no primary care physicians can accept new Medicare patients. According to a recent Definitive Health care study, 117,000 physicians nationwide left the workforce in 2021. Because patients cannot access physicians, wait times in California emergency departments average eight hours.
The Continued Fight: Advocating for Long-Term Payment Reform
Diverting the Medicare physician payment system away from its current unsustainable path and steering it instead toward physician practice sustainability will protect patient access to quality, evidence-based care while easing administrative burdens.
The American Medical Association (AMA) and multiple state and national medical societies – including the California Medical Association – have outlined a practical, commonsense approach to reforming Medicare physician reimbursement based on the principles of simplicity, relevance, alignment and predictability.
The need for change is clear. Taking inflation in practice costs into account, Medicare physician payment plunged 20% from 2001 to 2021. Medicare spending on physician services per enrollee retreated by 1% between 2010 and 2020, even as spending per enrollee for other parts of Medicare jumped by between 3.6% and 42.1%.
With inflation soaring to 40-year highs this year, statutory payment cuts looming, and many physician practices still dealing with pandemic-related financial issues, the current proposal from the Centers for Medicare and Medicaid Services (CMS) undermine the long-term sustainability of physician practices while threatening patient access to physicians participating in Medicare.
Leading the charge to reform Medicare physician payment is a core element of the AMA’s Recovery Plan for America’s Physicians, along with fixing prior authorization, supporting telehealth, reducing physician burnout and stopping scope of practice creep.
Physicians deserve payment models that recognize and invest in their contributions in providing high-value care to patients, while generating cost savings across all parts of Medicare and the broader health care system. In practical terms, this means directly rewarding the value of care that physicians offer to patients, as opposed to administrative tasks such as data entry that are often irrelevant to the service being provided.
Advancing value-based care also means encouraging innovation with practices and systems with an emphasis on continuous improvement, boosting the overall quality of care provided to the full spectrum of patient populations, including higher-risk and higher-cost groups. Ideally, a variety of payment models and incentives tailored to the distinct needs of different specialties and practice settings should be in place, along with a financially viable fee-for-service model.
And because the need to embed racial justice and advance equity across all aspects of medicine has never been greater, payment model innovations should be risk-adjusted and reflect the ongoing contributions of physicians to dismantle health disparities. Physicians who address social drivers of care need support as they provide care to historically marginalized, higher risk, and harder-to-reach patient populations. This support should extend to practices of all sizes and in all locations.
One of the biggest problems under the current payment system is the fact that other Medicare providers benefit from built-in updates, such as a medical economic index or an inflationary growth factor, that help offset increases in the cost of providing services – but no such offset exists for physicians.
Just as we didn’t get where we are overnight, we are unlikely to secure the massive, badly needed overhaul of the Medicare physician payment system tomorrow. The good news is that we can get there through single-minded determination and the collective efforts of our association, our counterparts in the Federation of Medicine, and the AMA.
Working together, we can place the Medicare payment system back on a sustainable path and ensure that our patients receive the quality care they deserve.
Burnout is extremely high among practicing physicians, with recent studies showing nearly 44% of U.S. doctors reporting one or more symptoms of burnout, depression, or both. Physicians are also at 50-300% increased risk for death by suicide compared to professionals in other fields.
To combat physician burnout, NSMS created the Together in Medicine program. The program aims to improve physician wellness by connecting physicians to their peers, building physician camaraderie, providing fun opportunities for to enjoy time with family away from the office, providing resources to strengthen resilience and leadership skills, and showing appreciation for the work physicians do.
NSMS has been working closely with both Drug Safe Solano and the Napa Opioid Safety Coalition to promote safe and appropriate prescribing practices and reduce prescription drug abuse in our communities.
Drug Safe Solano
DSS is working to reduce the number of residents who are prescribed highly addictive opioid medications and to improve medication safety and treatment strategies. According to recent research, the opioid crisis has hit Solano County particularly hard. In fact, Solano County opioid overdose hospitalization and emergency department rates exceed the state average. Because the causes and effects of prescription drug abuse are complex, a multi-disciplinary comprehensive approach is necessary to address this issue. Many organizations have partnered with the Coalition, including the Napa Solano Medical Society, leaders from our community hospitals and health plans, Solano County Public Health, Solano County Courts, law enforcement and other first responders. Visit their website for more information at www.drugsafesolano.com.
Napa Opioid Safety Coalition
The Napa Opioid Safety Coalition originally formed in 2014, under Partnership Health Plan's Managing Pain Safely program. Partners in the coalition include the Napa Solano Medical Society, Ole Health, Partnership Health Plan, Kaiser, Queen of the Valley Medical Center, Veterans Home, Napa County Health and Human Services Agency, Napa Police Department, Sheriff’s Office, community pharmacists, Up Valley Family Center, and community members. For more information about the Napa Opioid Safety Coalition, please contact (707) 253-4270.