As physicians face high inflation rates and skyrocketing practice costs, many feel Medicare pay is insufficient.
Udaya Bhaskar Padakandla, MD, president of the Texas Society of Anesthesiologists, joined Becker's to discuss the changes he'd like to see to the Medicare pay system.
Editor's note: This interview was edited lightly for clarity and length.
Question: What changes would you like to see regarding physician pay and reimbursements?
Dr. Udaya Padakandla: The major change I would like to see to physician pay is on the Medicare side. Medicare pay has been very unfair to physicians every year based on inflationary adjustments. Medicare has only been giving noteworthy positive adjustments for hospitals and other facilities. For physicians, CMS reduced physician pay 1.69% this year while giving a positive 3.34% adjustment to hospitals, long-term home-care facilities and ASCs. In the last 30 years, on the inflationary scale, physicians have seen a 29% decline from CMS in their compensation. The fundamental change I would like to see is that we can get this rectified and reform physician payment.
On the insurance side, many payers have been trying to follow Medicare as their benchmark and trying to fix their market rates based on what Medicare pays physicians. That's unfair because Medicare payments are decided by how much money is in the Medicare Trust Fund, not on the market value. It's unfair for these companies to collect premiums at a commercial rate, but then they're trying to pay the physicians at Medicare rates. It's a very lopsided way of doing things. Medicare just cannot be the benchmark for private insurers.
A second major step that insurers have brought about in the last few years is the No Surprises Act at the federal level. Insurers are trying to sweep all physicians and physician groups under one giant rug of network participation with a compensation rate totally decided by their bean counters. There are numerous problems for physicians in the context of NSA: no ability to negotiate rates with insurers, qualifying payment amounts are decided by payers, payers are ignoring the arbitration decisions made by independent arbitrators (a majority of which are decided in favor of physicians, by the way), and most importantly, all the rules being written in NSA legislation are rigged in favor of payers! The four lawsuits brought by the Texas Medical Association have halted some of these badly framed rules, but there is still a long fight ahead.
They have also brought up more obstacles like prior authorizations, which deny a whole lot of payments to physicians (and procedures to deserving patients), sometimes even after the fact. There are cases where the payers say yes, the patients get the procedure done, and then a couple of months later they tell patients the surgery is not approved and deny payment to physicians or worse still, recoup the money already paid.