Doctors in Congress are looking for a permanent fix for Medicare payment problems

House doctors want to revamp how Medicare pays doctors, which could give health care providers a pay boost in the coming years.

Lawmakers with medical backgrounds say the time is right and they are in key positions in this Congress to end what has become an annual frustration of avoiding billions of dollars in Medicare pay cuts for doctors and hospitals. The annual cuts to the General Health Insurance Program for the elderly and disabled are a side effect of the current wage structure and rules established by Congress to limit federal spending. But those efforts will face headwinds from some Republicans who are more focused on cutting spending.

If successful, the effort would be a huge win for healthcare providers who treat Medicare patients by increasing physician pay and ending the threat of looming cuts. It could also address two problems that have long plagued Medicare: its payment system is not keeping pace with the broader economy, which is creating the potential for doctor shortages, and it is a growing share of federal spending. The effect that increased Medicare payments to physicians will have on spending will be determined.

“Every year we’re going to have to find a way to stave off these legal cuts,” said Rep. Larry Bookchon (R-Ind.), a heart surgeon before joining Congress. “Nobody on either side of the aisle thinks this is a good idea.”

A doctor works on the floor of the intensive care unit treating Covid-19 patients at Hartford Hospital in Hartford, Connecticut, in January 2022.

Photographer: Alison Diner/Bloomberg via Getty Images

These statutory cuts are built into existing law, but Congress has regularly delayed or at least partially avoided them for more than a decade in response to pressure from physicians, said Joseph Antos, a senior fellow who studies health care policy at the American Enterprise Institute. . For example, Congress moved late last year to halve scheduled cuts in physician payments, to 2% compared to the 4.5% originally set by Medicare. This cut grows to 3.5% in 2024.

But Antos said the doctors’ groups do not publicly praise Congress for the help.

“It’s always a game of negative sum politically; doctors who have been helped will say ‘thank you, but you haven’t done enough for us’, and those who haven’t been helped will complain.”

Doctors’ groups have warned that leaving the cuts in effect could lead to a long-term shortage of doctors serving Medicare patients, particularly in rural areas or other disadvantaged areas.

Physician payments by Medicare, unlike those for hospitals, are not correlated with inflation and are not expected to keep pace with the average physician cost increase rate, according to the latest Medicare trustees. Report, which looks at the overall financial condition of the programme. This means that costs of operating practices are rising faster than Medicare payments, creating an incentive for physicians to participate in the program.

Bipartisan payment

While Medicare may not pay some doctors enough to ensure that seniors across the country can get care, the program also faces bankruptcy by 2028, according to the trustees’ report.

Antos said there is little sign that Congress will make broader payment changes that will lower Medicare’s growth rate going forward. “No one has seriously talked about it for some time,” he said.

But lawmakers in the eight-member so-called Doctors’ Caucus say they aim to start those talks in earnest this year.

Rep. Raul Ruiz (D-Calif.), an emergency room physician, said the group requested input last year and will submit recommendations for legislation that revamps the Medicare payment system sometime this year. He said the group had not yet agreed on the details of these recommendations.

Bouchon said they are also pressing major committees to hold hearings on the issue in Congress to drum up support.

The gang holds key positions to get this done: Bookchon along with his fellow medical practitioners, past or present. Michael Burgess (R-Texas), Marianette Miller Meeks (R-Iowa), Ruiz, and Kim Schrier (D-Wash). Sit on the Energy and Commerce Committee, which has jurisdiction over some Medicare programs. Rep. Brad Weinstrup (R-Ohio) is a member of the GOP Doctors Caucus and sits on the Ways and Means Committee.

Doctors’ groups have complained for years that Medicare’s payment system doesn’t keep pace with inflation and other costs health care providers face. Groups like the American Medical Association, the nation’s largest physician lobby group, have sought to boost what the public health insurance program pays to health care providers in rural and urban areas where there are shortages of physicians.

Increasingly, doctors are working on narrow margins, especially small and rural practices, warned Jack Resnick Jr., president of the American Medical Association.

“The elderly and doctors deserve a stable payment system for Medicare that ensures access for future generations,” he said in a statement.

political headwinds

A major congressional advisory committeeThursday recommended Lawmakers will raise Medicare payments next year for doctors and hospitals that serve large numbers of low-income recipients.

For Republican lawmakers, at least, the push to increase doctors’ pay could be complicated by efforts within the Republican Party to cut government spending more broadly this year.

House Republican leaders have pledged not to support an increase in the state’s debt limit unless it is accompanied by cuts in federal spending. Health care is a big part of that: Medicare accounts for about 12% of all government spending in fiscal 2022, roughly $755 billion, according to Treasury numbers.

House Speaker Kevin McCarthy (R-Calif.) told reporters Jan. 12 that while he wants spending reform, he doesn’t want to cut Medicare spending. The issue has long been the third issue of Congress.

But avoiding cuts does not mean lawmakers favor spending more. Bookchon said he knows it will be difficult to convince his colleagues that some Medicare spending should be increased, but he says it’s a worthwhile effort.

“We are at a stage where payment problems are hindering access to quality medical care,” he said.

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