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Yahoo
5 days ago
- Health
- Yahoo
Physicians are working more but reimbursement isn't keeping pace, report finds
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. Dive Brief: Physicians are working more than ever, but reimbursement isn't rising in tandem. It's a worrying mismatch that could translate into access problems for patients down the line, according to a new report. Physician productivity, as measured by a metric of how much work goes into providing a specific service, has grown 11% over the last two years, according to the report from consultancy Kaufman Hall. However, patient revenue per each work relative value unit dropped 7% over that time — and provider compensation per work relative value unit dipped 2%, Kaufman Hall found. Dive Insight: Physicians have been sounding warning bells for years about unsustainable reimbursement. Medicare reimbursement for physician services fell 29% from 2001 to 2024 when adjusted for inflation, according to the American Medical Association. The reimbursement shortfall stems from the fact that Medicare's payment to doctors isn't adjusted for inflation, and year-to-year adjustments are required to be budget neutral. Regulators say this makes it impossible for them to bump reimbursement to the level doctors say they need. Meanwhile, Medicaid rates for physician services are even lower than in Medicare — and higher reimbursement from commercially insured patients often fails to make up the difference, according to doctors. Reimbursement pressures have recently coincided with sharp inflation and rising labor expenses, resulting in winnowing margins for physician practices. That's led many to sell, often to large corporate buyers like hospitals or insurance companies, or close altogether. Other physicians are leaning more into expensive elective care or switching to concierge medicine to entice wealthier patients into their practices. But either way, access to physicians is shrinking for many Americans, experts say. 'Revenue has increased because physicians and providers are working more, but the data also show that reimbursement is not keeping pace. In the coming months if more patients lose insurance coverage, this trend will likely get worse,' Matthew Bates, the managing director and physician enterprise service line leader at Kaufman Hall, said in a statement alongside the release of the report Monday. Roughly 10 million Americans are expected to lose health insurance coverage as a result of the GOP's mammoth tax and policy law passed last month. Another 4 million should lose coverage if more generous subsidies for Affordable Care Act plans expire at the end of this year, according to estimates from nonpartisan scorekeeper the Congressional Budget Office. Some lawmakers in Congress have expressed support for reforming doctor reimbursement in hearings and in public letters. One policy, to link annual Medicare reimbursement updates to a measure of cost inflation, is backed by physician associations, an influential congressional advisory group and legislators on both sides of the aisle. (A bipartisan group of representatives introduced a bill in the House two years ago making the change, but it's seen little movement.) A recent CMS rule overhauling the physician payment system includes a Medicare base rate hike of 2.5% for doctors next year. But other policies in the rule means its impact on reimbursement will vary wildly based on a physician's specialty and site of practice. As such, it was met with mixed reactions from doctors. Recommended Reading CMS proposes rule aligning Medicare physician payment with 'Big Beautiful Bill,' MACRA Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Axios
6 days ago
- Health
- Axios
Why more doctors can't make ends meet
America's doctors are working harder and getting paid less. And that could soon translate into less access for some patients. The big picture: A new report from consultancy Kaufman Hall shows primary care physicians and specialists are delivering more services since the pandemic. But they're not making more money because of stagnant reimbursements from public and private insurers and inflation. The data helps explain why medical practice bankruptcies hit a six-year high last year — and why some providers are shifting to pricey procedures for cash-paying customers to boost their bottom lines. By the numbers: There was a roughly 5% increase in net revenue per full-time provider between the second quarters of 2023 and 2025, Kaufman Hall said, based on data from more than 200,000 clinicians across the country. But over the same period, the amount of net revenue per unit of work — generally understood to mean how much a physician generates for the volume of work they put in — fell 7%, the report found. Between the lines: A reckoning may not be far off, with millions of Americans projected to lose coverage due to changes in Republicans' tax-and-spending bill. "In the coming months if more patients lose insurance coverage, this trend will likely get worse," said Kaufman Hall managing director Matthew Bates. The anticipated drop-off in income is compounded by rising labor costs, which already make up 84% of total expenses for medical groups. And some physicians struggle to find and hold on to good help. "At some point this growth in productivity starts to be impeded if the doctor has to go out and check in their own patients and take their vitals, they're not gonna be able to see as many patients," Bates said. The end of the COVID-19 crisis didn't improve business for many practitioners, as troubling trends that surfaced during COVID-19 have persisted. The consultancy Gibbins Advisors found there were 57 medical practice bankruptcies with more than $10 million in liabilities last year. While the bankruptcy filings have slowed this year, Clare Moylan, a principal at Gibbins, said it doesn't necessarily signal a turnaround. "The health care sector has a lot of macro shifts causing distress for providers," she said, pointing to persistent workforce shortages, elevated supply expenses and now, the threat of tariff-driven inflation. Meanwhile, bankruptcies amid smaller practices of between $500,000 and $2 million in revenue have been steadily rising in the last two to three years, said Daniel Gielchinsky, a partner at DGIM Law in Florida who specializes in bankruptcies. Between the lines: Among the disturbing trends Gielchinsky has observed are medical practices branching into med spa-like services and investing in Botox supplies and skin-tightening lasers in hopes of capturing wealthy patients seeking elective procedures. They're finding out that consumers have less disposable income than they expected, and the competition is fierce. "We had one bankruptcy where the equipment was literally unused. They didn't get a single patient in the door to do any laser treatments, but they've had this $800,000 machine they're making payments on every month," he said. Many doctors have opted to sell their practices to a health system or private equity firm. But critics say that has accelerated the corporatization of medicine and put power in the hands of for-profit entities that have raised prices and put shareholder value above patients' interests. The other side: Doctors could see up to a 3.8% increase to their Medicare payments next year under a Trump administration proposal released earlier this summer. But to maximize their reimbursements, practices would have to agree to be paid based on patient outcomes instead of the volume of services delivered. "There is a little relief on the reimbursement side coming in 2026 to help combat those headwinds," Moylan said.
The Independent
07-05-2025
- The Independent
Utah judge to decide if convicted killer with dementia can be executed
Attorneys for a Utah man who has been on death row for 37 years are due before a state judge Wednesday as they seek to spare the convicted murderer from execution because he has dementia. Ralph Leroy Menzies was sentenced to die in 1988 for the killing of Maurine Hunsaker, a mother of three. His attorneys say the 67-year-old inmate's dementia is so severe that he cannot understand why he is facing execution. If he is deemed competent, Menzies could be one of the next U.S. prisoners executed by firing squad after the method was used on two South Carolina men in recent weeks: a man convicted of killing his ex-girlfriend's parents in 2001 and a man who killed an off duty police officer in 2004. Medical experts brought in by prosecutors say Menzies still has the mental capacity to understand his situation, while those brought in by the defense say he does not. The hearing Wednesday will be the last in Menzies' competency case before Judge Matthew Bates issues an opinion, said Eric Zuckerman, a lawyer for Menzies. Menzies is not the first person to receive a dementia diagnosis while awaiting execution. The U.S. Supreme Court in 2019 blocked the execution of a man with dementia in Alabama, ruling Vernon Madison was protected against execution under a constitutional prohibition against cruel and unusual punishment. Madison, who killed a police officer in 1985, died in prison in 2020. That case followed earlier Supreme Court rulings barring executions of people with severe mental illness. If a defendant cannot understand why they are dying, the Supreme Court said, then an execution is not carrying out the retribution that society is seeking. 'It's not just about mental illness. It can be also the consequence of brain damage or stroke or dementia — the fundamental question being whether he has a rational understanding of the reasons he is being executed,' said Robin Maher, executive director of the Death Penalty Information Center. More than half of all prisoners sentenced to death in the U.S. spend more than 18 years on death row, according to the organization. Menzies earlier chose a firing squad as his method of execution. Utah death row inmates sentenced before May 2004 were given a choice between that and lethal injection. For inmates sentenced in the state after that date, lethal injection is the default method of execution unless the drugs are unavailable. Since 1977 only five prisoners in the U.S. have been executed by firing squad. Three were in Utah, most recently in 2010, and the others in South Carolina. Hunsaker, a 26-year-old married mother of three, was abducted by Menzies from the gas station where she worked. She was later found strangled and her throat cut at a picnic area in the Wasatch Mountains of northern Utah. Menzies had Hunsaker's wallet and several other belongings when he was jailed on unrelated matters. He was convicted of first-degree murder and other crimes. Over nearly four decades, attorneys for Menzies filed multiple appeals that delayed his death sentence, which had been scheduled at least twice before it was pushed back. Zuckerman said there will be further hearings before any execution warrant can be issued. ___ Brown reported from Billings, Montana.
