CMS proposed a 2.8% conversion factor reduction to its physician fee schedule for 2025 July 10.
Ten physicians joined Becker's to discuss the move and what steps should be taken in response.
Editor's note: These responses were lightly edited for clarity and length.
Harel Deutsch, MD. Co-Director of the Rush Spine Center (Chicago): Physicians pay has generally been dramatically reduced due to inflation over the past few years and CMS cuts would be adding insult to injury. There will be a lot of consequences to the reduction in physician pay. Increasingly, patients do not see doctors. I routinely review records where patients only saw physician assistants and advanced practice nurses for years for sometimes complex problems. My opinion is that the patients would have benefitted from seeing a doctor in many of those cases. Treatment with PAs and APNs also results in more orders for tests, consults and expenses. We cannot find doctors for many patients on Medicare for many specialties. Patients have to wait for months to see an endocrinologist. Physicians increasingly have to depend on other income sources for revenue.
Brad Lerner, MD. President of Chesapeake Urology Associates and Medical Director of United Urology Group Ambulatory Surgical Centers (Baltimore): It is extremely disappointing to hear about any proposal that would devalue the ongoing efforts of physicians to provide the highest quality level of safe, compassionate patient care. Along with increasing regulatory and compliance demands as well as non-clinical tasks that require additional hours of time, this proposal, if approved, could potentially lead to higher physician attrition and shortages in the workforce.
Bert Mandelbaum, MD. Sports Medicine Surgeon in Santa Monica, Calif.: The proposal to cut physician pay is inordinate and inappropriate at this time. There is no question that healthcare costs are rising. All goods and services in our economy have been inflationary, but to single out physicians is not a well thought-out strategy. My approach would be to empower the physician to be more efficient, valuable and responsive as the initial tactic rather than restricting pay.
Manoj Mehta, MD. Gastroenterologist at the Endoscopy Center of the North Shore (Chicago): Medicare's annual reduction in reimbursement for physician services is a key driver of patient dissatisfaction with the healthcare system. By reducing payments for individual services, Medicare drives physicians to perform volume-based practices. For primary care physicians, this is the reason why some patients express that they only see their doctor for 5 minutes each visit, and the whole office is run like an assembly line. For procedure-based specialists, it drives physicians towards a model where they perform an inordinate number of procedures in a day, and do no consultative or follow-up work. "Want to discuss results? Go see your PCP, I'm only here to do the procedure!" Any volume-based model will sacrifice quality for quantity, and we are well aware that patients want and need quality care. Any conscientious physician who strives to do this will soon be out of business in the current model, unless they adopt even more isolating models like concierge medicine. If you are a patient who is frustrated by doctors treating you like a number, or charging extra fees, look no further than the Medicare reimbursement model to blame.
Thomas Miller, MD. Professor of Orthopedic Surgery at Virginia Tech Carilion School of Medicine (Roanoke): Reduction of provider compensation is an easily visible and token response to increased healthcare spending. Are some specialties overpaid, yes. Are some underpaid and underappreciated, yes again. The greatest impact will be disproportionately felt by physicians most essential in long-term health maintenance. The actual costs and inefficiencies will not be addressed an if anything, the long-term fiscal impact and level of health services will be negatively impacted.
Thomas Pliura, MD. Physician and Attorney in Le Roy, Ill. The CMS proposal to continue making physician reimbursement cuts is not sustainable. As an example, in regards to various state Medicaid programs, medical providers and physicians have seen such dramatic cuts in reimbursement if public aid/Medicaid programs that many physicians refuse to see patients covered by state Medicaid programs. This results in a perception that Medicaid patients have insurance coverage, but in reality there is a lack of physicians willing to see patients covered by public aid, due to low reimbursement. So while a public aid patient may technically have insurance coverage, the reimbursements are so low that few high quality or specialized physicians are willing to provide that patient with services.
Donald Olson, MD. Pain Management Specialist in Tillamook, Ore.: To further reduce reimbursement would mean less cash flow spread out over time. In today's economy something would have to give, probably less service and much less availability. In my opinion, a trainwreck.
Thomas Schuler, MD. Spine Surgeon and Founder at Virginia Spine Institute. Cuts to medicare physician reimbursement is an attempt to control access to care by making it financially untenable to provide care to the patient's covered by it. This is a way for the government to implement death panels without having to directly deny care. Access to care will decrease for patients with fewer physicians accepting these dwindling payments. The bigger problem is that other insurers use Medicare payment cuts as an excuse to follow this payment model, impairing the financial solvency of practicing physicians.
Kristopher Schroeder, MD. Anesthesiologist and Professor at University of Wisconsin School of Medicine and Public Health (Madison): In an era where we are only now emerging from spiraling inflation and our early career faculty continue to struggle with substantial education debt burdens, electing to cut physician reimbursement appears beyond foolish. Not only does this proposal dishonor those who risked everything and were lauded as heroes in the setting of the COVID-19, it sets in motion a pathway that codifies a lack of respect for physicians and the important work that they do.
Anthony Yeung, MD. Spine Surgeon at Desert Institute for Spine Care (Phoenix): I think physician reimbursement and the current political environment is bad for all physicians who will be working for hospitals and insurance companies. The healthcare environment is not favorable for physicians.