Physician leaders are frustrated and concerned about CMS' proposal for a 2.8% conversion factor reduction to its physician fee schedule for 2025.
Ten physicians joined Becker's to discuss the long-term dangers of this proposal.
Editor's note: These responses were edited lightly for clarity and length.
Mohammad Agha, MD. Neuromuscular Fellow at Yale New Haven (Conn.) Hospital. There are multiple dangers in different time horizons. In the short to medium term, this will lead to a ripple effect impacting the setting of physician practices. In the short term, as cuts to physician pay continue, more physicians will opt for employment or direct-care models. Medium term, as these direct models proliferate, there is the risk that e wealthier patients will access these physicians while those who aren’t will continue to go to hospital systems. I acknowledge that not all cash pay models cater to the wealthy, but with declining reimbursement, the incentive to switch due to reimbursement reasons will increase.
As hospitals now take on patients that don’t have the wealth to opt out, this will lead to a lower payer mix which will squeeze health systems and force them to examine new care models to finance their futures. While this may lead to some institutions innovating, those who don’t have the resources to navigate the transition will shut down, worsening access across the country. Increasing the number of financially vulnerable hospitals will accelerate health system consolidation.
As physicians and health systems struggle to figure things out, another scenario is that this gives an opening for other market players (like insurers) to increase practice acquisitions. Payers have even more power in the marketplace than the current state. While these cuts may lead to some long-term innovation, the short to medium term will be turbulent for almost everyone.
Ernest Braxton, MD. Spine and Neurological Surgery Specialist at Vail-Summit Orthopaedics and Neurosurgery (Vail, Colo.): This will be the last straw for many private practice physicians. We will see more early retirements and a large number of physicians opting out of Medicare in order to create private pay contracts with patients for non-urgent/emergency care, shifting the economic burden to healthcare consumers.
Adam Bruggeman, MD. CEO and Surgeon of Texas Spine Care Center (San Antonio): Continued cuts in the face of unprecedented consolidation while at the same time facing high inflation will lead to a continual collapse of private practice. This leads to reduced access, increased costs and lower quality. Physicians are rapidly leaving independent practice and this will only accelerate the run to the exits. Congress must stop putting the thumb on the scale of corporatized medicine.
Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: It is now very likely if not a fait accompli that it will now cost physicians to see Medicare patients. If you amortize out the cost of rent, malpractice insurance, employee salary and equipment, seeing a new Medicare or follow-up will be a net loss to the practice. That’s not an accident. It’s a system that’s being driven to failure to facilitate entry into single payer. The misguided thinking this will somehow make things cheaper and better is the equivalent of having water run uphill. We will discourage people from entering medicine, drive early retirement and leave medicine altogether. The plan for that is to substitute other people for physicians. People deserve a doctor if they want one. It’s just clear the government doesn’t think so. The Medicare trust is funded by taxpayers’ money. This is mismanagement. Liquidating the trust and a voucher system won’t work either as who will help patients navigate such a system. If the next or any other administration decides to roll up Medicare, Ifor one want all my contributions back - with interest.
Nameer Haider, MD. Interventional Pain Specialist and Owner of Omni Pain & Precision Medicine (Utica, N.Y.):
- Decreased access to care
- Increased patient wait times: Financial strain might force practices to limit patient loads, potentially increasing wait times for surgeries and affecting patient care.
- Reduced services: Some practices might reduce or eliminate certain services or procedures, affecting patient care options.
Thomas Miller, MD. Professor of Orthopedic Surgery at Virginia Tech Carilion School of Medicine (Roanoke): Those physicians in low-reimbursement specialties (any non-intervention specialty such as primary care, internal medicine, pediatrics) already work at narrow margins and carry a disproportionate burden of unfunded mandates on how they practice.
Additional reductions in reimbursement will narrow those margins. Those currently in practice may choose selectively accept fiscally viable patients via elimination of Medicare access, shift to a concierge model, or may choose to leave medicine altogether (Yes, there are plenty of providers who practice for the love of the profession, but have finally reached the "enough-is-enough" stage), those considering these underappreciated specialties may choose other career paths, all resulting in selective and reduced access to front-line care.
The end effect is lack of preventive care, delayed care and shift to interventional/invasive care. The most cost-effective fiscal health care management is preventative but with only 15% of healthcare cost being physician based, this approach seems misguided and fiscally irresponsible.
Amit Mirchandani, MD. Founder of Seva Pain and Wellness (Lewisville, Texas): With continued cuts, physicians will be forced to limit the number of Medicare patients they see. They will not grow their practices. They will not innovate. They will not thrive. Some physicians may leave the profession or retire early because the immense care and effort it takes to care for our elderly may not be worth the diminishing reimbursement. And possibly worst of all, physicians may not encourage their own children to become physicians themselves. This pedigree and pipeline has typically been strong, but could dry up within a generation of burnt-out physicians. This will undoubtedly lead to lower qualified students becoming physicians in the future. I know these things because I have consulted and helped many independent practices with the rising costs of healthcare.
Some solutions have been to reduce onsite office staff, use digital assistants and integrate overseas virtual assistants to help support independent practices. In addition, creating a cheaper, yet more robust revenue cycle support system that can serve many practices has been very rewarding. These are lifelines that are now very necessary for physicians to survive and continue to have a solid medical career. Medicare really should think twice (and possibly three times) about cutting physician reimbursements.
Consider giving physicians MORE reimbursement, which will lead to more independence, and more control of the care a patient gets. Giving this control to the insurers and hospitals has been horrific. Strengthening physicians is the only way the U.S. can save the overly expensive, under performing healthcare system.
Stan Plavin, MD. Anesthesiologist and owner of Oral Surgery Anesthesia Associates. As a physician; it is disheartening to constantly battle every year to reduce cuts. The day will come when physicians will not be able to provide services to the patients that we hold near and dear in our hearts. This is unfair to all parties and monies need to be allocated more appropriately to physician services.
Thomas Pliura, MD. Physician and Attorney in Le Roy, Ill. I believe continued cuts in Medicare reimbursement will drive even more physicians out of the prospective pool of providers available to Medicare recipients. The long-term viability of the Medicare program may likely be threatened by these continued cuts.
Christian Zimmerman, MD. Neurosurgeon in Boise, Idaho. Considering the current state of this nation's economy, debt burden and outlook, these reductions are neither surprising nor unexpected. Large hospital systems and their employed physicians have experienced reduced revenues, pay cuts and capital budget freezing since the pandemic crisis, resulting in stalled growth, and in some cases, elimination of service lines altogether. Albeit small in scale to previous reductions for CMS patient services, these actions will continue to impact the neediest of patients and further divide healthcare delivery systems and those who render that care. Our community and many of its physicians already exclude certain insurance profiles, so these actions will only certainly be reinforcing this behavior further.