In an period of rising prices for every part from groceries to gasoline to healthcare, unbiased physicians are actually going to obtain much less — no more — for taking good care of our most-vulnerable residents, our seniors, furthering a disaster that has been deepening for years.
Final month the federal authorities not too long ago launched a proposed replace to a coverage that almost all Individuals have by no means heard about however might very effectively have a profound impression on their subsequent physician’s appointment. That coverage — the Medicare Doctor Payment Schedule — determines how a lot healthcare suppliers get reimbursed for treating sufferers coated by Medicare.
And that reimbursement goes down, but once more.
Whereas reimbursement charges for hospitals persistently climb with inflation, together with a 2.6% improve going into impact later this yr, the reimbursement charges for physician’s workplaces don’t. In consequence, in keeping with the AMA (American Medical Affiliation), the Medicare reimbursement for physician’s workplaces, when adjusted for inflation, is down virtually 30% since 2001. Regardless of this widening disparity, the federal government has simply proposed reducing the reimbursement price for physician’s workplaces by 2.93%.
It’s straightforward to suppose this replace to the doctor payment schedule will solely impression sufferers on Medicare, however that’s not the case. These reimbursement cuts aren’t taking place in a vacuum; they’re a part of an ideal storm of calls for and challenges to unbiased suppliers throughout the nation. As practices battle to remain afloat financially, this replace might deeply impression physicians and their capability to serve all sufferers with high quality care.
America’s physicians are experiencing widespread burnout as a consequence of administrative workloads, staffing shortages, regulatory necessities, and rising affected person calls for. Compounding this burnout is a rising aged inhabitants in want of care, with an estimated 11,000 individuals becoming a member of Medicare every day.
In the meantime, physicians are paying extra for labor, lease, and medical provides. Many are additionally recovering from the consequences of February’s cyberattack on well being fee processing large Change Healthcare, which created an infinite backlog of unpaid claims and critical cashflow issues.
The potential monetary impression of the proposed modifications can be one other blow, and if accredited, already cash-strapped practices might wind up shedding workers, decreasing hours or making different modifications that ultimately will impression all sufferers. The impact could possibly be biggest amongst bigger practices, particularly these in specialty disciplines who see a disproportionate variety of older sufferers.
For those who discuss to physicians, as I do on a regular basis, it isn’t exhausting to note what number of say they fear that their follow will not be financially sound and are contemplating main modifications to their follow operations to offset monetary burdens.
Right here’s the worst-case situation. Practices may have much less time to spend with every affected person, as a result of they might want to fill their schedule with increasingly sufferers to make the numbers work. Some practices could cease taking new Medicare sufferers or drop Medicare altogether, leaving our most weak seniors struggling to entry high quality and well timed care. Different docs will change to concierge care, obtainable solely to these capable of pay a hefty annual payment.
We don’t fault the federal government for attempting to maneuver Medicare to a extra quality-based system. Nonetheless, persevering with to arbitrarily lower fee-for-service reimbursement is doing extra hurt than good.
And others agree. The American Bodily Remedy Affiliation referred to as final yr’s fee cuts “devastating.” The group “strenuously opposes any try to cut back fee for bodily remedy below Medicare.”
The American Hospital Affiliation stated that 2024’s proposed cuts “would pose important dangers to sufferers’ entry to care and well being techniques’ monetary stability, significantly for suppliers serving traditionally marginalized communities.”
And MedPAC, the Medicare Fee Advisory Fee — has expressed its concern that as medical procedures proceed to be reimbursed at a better price than analysis and administration, extra practices will concentrate on higher-value providers in lieu of less-profitable however truly cost-saving work, akin to preventative care.
The answer is easy … pay physician’s workplaces what it prices to deal with the affected person.
The American Medical Affiliation and 120 state medical societies help the Strengthening Medicare for Sufferers and Suppliers Act (H.R. 2474) at the moment pending in Congress. This bi-partisan invoice would tie Medicare doctor reimbursement to medical inflation, thus completely linking the reimbursement for treating a senior with the precise value of that therapy.
Physician’s workplaces are the entrance door of the American healthcare system. We owe it to them to help H.R. 2474 and put an finish to annual Congressional stop-gap spending payments. Now could be the time to put money into the insurance policies, applications, and applied sciences that construct extra resiliency on this most important infrastructure and help those that help us in our time of want. Our collective well being is dependent upon it.
Picture credit score: mkurtbas, Getty Photographs
Bob Segert is the Chairman and CEO of athenahealth, an organization that delivers network-enabled software program and providers to greater than 150,000 healthcare suppliers, who collectively take care of practically 1 / 4 of the U.S. inhabitants.
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