Congress Needs to Hear from You: Protect America's Medicare Patients

Physicians are facing another round of Medicare payment cuts by the Centers for Medicare and Medicaid Services. Unless Congress acts by the end of this year, physician Medicare payments are planned to be cut by 8.42 percent in 2023, which would severely impede patient access to care due to the forced closure of physician practices and put further strain on those that remained open during the pandemic. These scheduled cuts will come in the form of:

  • Centers for Medicare & Medicaid Services. CMS has proposed a 4.42% cut for all physician services in 2023 to offset payment policy improvements in office and facility-based visits.
  • No inflationary update.  Physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update; during this time of record inflation on the heels of a highly disruptive pandemic, this statutory flaw amplifies the impact of proposed payment cuts.

When adjusted for inflation, Medicare physician payments have dropped by 22% from 2001 to 2021. Physicians simply cannot afford to operate under the current payment system.

Immediate Congressional Action is Needed

Recently, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced H.R. 8800, the "Supporting Medicare Providers Act," to help address the flawed payment system and provide relief from devastating cuts. With only a handful of days before the election, it is critical that Congress act to pass this or any other legislation that will prevent these devastating cuts in the "lame duck" session.

Congress needs to hear directly from physicians about how these cuts will impact your patients and your practice. Please call your Member of Congress and U.S. Senators frequently between now and the end of the year to urge them to support H.R. 8800. You can also send messages through their websites, on Twitter, or use CMA's Voter Voice site. They need to hear in personal terms how these cuts will impact access to care for Medicare patients in their communities. Please take a moment and contact your Senators and Representative to tell them to cancel the cuts! And please keep calling and writing until they act. You can contact your members of Congress here:

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.