Years of Medicare Neglect Have Hurt Patients the Most

Medscape

a day ago

Every year, the cracks in the Medicare physician payment system widen. And with each year that Congress and the White House fail to act, physicians pay the price — and so do their patients.
Patricia L. Turner, MD, MBA
This year marks the fifth in a row physicians endured across-the-board cuts to Medicare payment, even as the cost of care climbs. Moreover, Congress and multiple administrations have neglected to meaningfully reform Medicare payments to physicians over the past 30 years. The consequences of this failure are manifesting in long times in waiting rooms, increased hospital visits, and decreased access to care.
Keeping this in mind, we must dispel some common misconceptions about payment. Let us be clear: Physician payment is not the same as what doctors take home in salary. Those dollars are what keep practices afloat; ensure clinical and administrative staff are compensated; allow investments in new technology and clinical supplies; pay rent, utilities, and other overhead costs; and, most important, afford patients across the country timely access to any care they need, whether it be with primary care or a surgeon.
R. Shawn Martin, MHCDS
When the payments fail to cover the full scope of these costs, as is the case now, staff wages stagnate, appointments are shortened to increase the number of patient visits, and, in some cases, physicians may not be able to receive a salary of their own just to keep the practice afloat.
Our country's physicians are burning out under these impossible choices, and future physicians are choosing other careers. We cannot afford to diminish our workforce when we need to grow it the most, given that our senior population is expected to double over the next 40 years. Communities suffer as a result.
Patients are not just losing access to care; they are losing lifelong relationships with trusted physicians, and they are losing access to care for cancer and after trauma. Meanwhile, they are experiencing delayed access to preventive care and screening, more chronic disease, and worse outcomes after emergencies and hospitalizations, all of which cause healthcare costs to skyrocket. These are not hypothetical situations but are a bleak reality that cannot continue.
The downstream effects don't stop with Medicare, which serves as a model for many state Medicaid agencies, managed care plans, and private payers. When Medicare underpays, costs everywhere are driven down, deepening the strain on practices and widening gaps in access for all patients. Outdated payments are particularly concerning given that other areas within healthcare, including hospitals, skilled nursing facilities, and other facilities, are seeing significant increases in payments.
Physicians are glaringly absent from this list. Primary care clinicians often are the first line of care for patients in communities large and small and rural and urban. Patients also risk losing critical access to surgical care. Many communities already lack enough surgeons to address the elective, urgent, and emergent needs of their residents.
The design of the current payment structure threatens surgical care in several ways. It distorts the true value of complex procedures and services and fails to keep pace with the rising costs of equipment, innovation, staffing, and compliance. Many surgeons are being forced to reduce their Medicare patient load — or exit practice entirely. The result? Longer wait times for routine operations that become complex, or postponed operations that can cause months of preventable pain and worse outcomes. For an aging population, these issues are more than mere inconveniences; they represent life-altering delays that can also increase long-term costs.
Safeguarding access to care for those who rely on Medicare should be nonnegotiable. Physicians want to care for patients and their communities and support their colleagues and staff, not face the consequences of a neglected and outdated payment system. Our leaders want high-quality care for their constituents. Congress must pursue real solutions.
Bipartisan solutions do exist. We've advocated relentlessly for policies that account for rising costs, including an annual inflationary update to Medicare payment and reforms to requirements for budget neutrality. We both agree these arbitrary restrictions undermine the positive effect of important policy and payment updates, preventing critical investments in primary and surgical care and pitting specialties against one another, all of which fails to prioritize patients and their well-being. Enacting these reforms would do more than stabilize physician practices; it would safeguard access to care for Medicare beneficiaries across the country.
The Medicare physician payment system is the scaffolding that supports the health of more than 60 million Americans. And right now, years of neglect are making the foundation crumble. If we want to truly demonstrate we care about patients, we must fix the system that supports the physicians and practices who care for them.