With Medicare cuts finalized, doctors and health groups press Congress for help

Physicians and advocates are bracing for reduced reimbursements and another cut due to the sequester, unless lawmakers intervene.

The planned Medicare cuts for physicians are moving forward, and now healthcare advocacy groups are pressing Congress to block them.

The Centers for Medicare & Medicaid Services this week approved the 2023 Medicare physician fee schedule, which finalized a reduction in the conversion factor determining payments for doctors.

As healthcare groups expected, and dreaded, the conversion factor will drop nearly 4.5% in 2023, compared to 2022. Most medical practices and doctors said Medicare’s reimbursement rates were insufficient even before the cuts for 2023 went into effect.

However, doctors and health systems are also bracing for the prospect of deeper cuts in Medicare under federal budget rules. Right now, Medicare is slated for a 4% cut under the Pay-As-You-Go (PAYGO) sequester, which is designed to ensure that federal spending doesn’t add to the deficit. Health groups have urged congressional leaders to stop the sequester.

Anders Gilbert, senior vice president of government affairs for the Medical Group Management Association, implored lawmakers to act. He stressed that lawmakers can’t pass it off until the next Congress is sworn in 2023.

“It is more critical than ever that Congress act to avert these cuts, as well as the 4% PAYGO sequestration, before the end of the year,” Gilbert said in a statement. “Ninety percent of medical practices reported that the projected reduction to 2023 Medicare payment would reduce access to care.”

The American Medical Association has been urging President Biden’s administration and lawmakers to stop the cuts in aid. Jack Resneck Jr., the AMA’s president, said the cuts would end up hurting doctors and patients, especially if the 4% sequester proceeds as scheduled.

“The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians,” Resneck said in a statement. “The AMA will continue working with Congress to prevent this harmful outcome.”

The American Academy of Family Physicians also warned about the harmful repercussions of the reduced Medicare aid.

“We strongly urge Congress to protect patients and support physicians by averting these cuts and investing in a more sustainable Medicare physician payment system,” Tochi Iroku-Malize, the AAFP’s president, said in a statement.

“Family physicians provide high-quality care to our patients and our communities, but inadequate Medicare payment rates strain physician practices and create barriers to care for beneficiaries,” Iroku-Malize said. “This trend cannot continue, especially amid a pandemic that has altered the health care landscape.”

The California Medical Association said, “If these cuts are allowed to take effect, these cuts will 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.”

Most medical groups said the Medicare cuts, if enacted, would hurt their practices, according to an MGMA report in September.

In a survey of more than 500 medical groups, 58% said they would limit the number of new Medicare patients, and 58% also said they would consider reducing the number of clinical staff. Almost a third of the practices (29%) said they would think about closing satellite locations. Two-thirds (66%) said they would consider reducing charity care.

More than nine out of 10 practices (92%) said Medicare rates are already inadequate in covering the cost of care, and that’s not including the projected cuts, the MGMA said.

Two members of Congress who are both physicians introduced a bill in September to block the cuts. U.S. Reps. Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.) are pushing bipartisan legislation to stop the Medicare cuts that are slated to take effect Jan. 1.