In any career, 25 years of dedicated work is a lot to let go of. In medicine, it amounts to hundreds of patient relationships, and the blood, sweat, and tears that go into starting and maintaining a practice.
Yet, after all that time, one of my physician colleagues recently had to let go of her beloved private practice -- not by choice and not without tears for her dear, elderly Medicare patients who now face fewer options for care. Her story is unfortunately not unique.
Physicians and their patients have suffered through more than 2 decades of uncertainty caused by precarious Medicare funding. We've seen how these cuts have forced unwanted changes in medical practices. While their practices stay open, the Medicare system underpays our nation's physicians to the point that some are forced to make difficult decisions about which patients they can care for. Eventually, when these practices barely have their heads above water, that "next round of cuts" proves to be the last straw.
Like clockwork, another Medicare physician payment cut is on the horizon for January.
I'm afraid the day is near -- if not already here -- that there will not be enough physicians to take care of Medicare patients. Physicians who participate in the program are forced to do more with less, which leaves no good choices. The situation hinders our ability as physicians to provide the complex, quality care these elderly and sometimes disabled patients need, and prevents us from seeing as many Medicare patients as we would like. Furthermore, it contributes to burnout and moral distress because we can't do what we swore an oath to do, which is to put our patients first.
Medicare Physicians' Plight
As president of the Texas Medical Association (TMA), I hear concerns from our physician members as they face ongoing practice viability challenges.
"If this additional [Medicare] payment cut goes through, in the midst of inflation and COVID causing rising costs for staff salaries and benefits, I would have no choice but to stop caring for these patients," a worried physician shared with TMA.
"We are dying," said another. "I can't even keep a full staff. All the doctors I have referred patients to are leaving or gone."
"I'm terrified for what this will mean for my elderly patients and their access to care," yet another concerned doctor said.
"The mental stress of making ends meet is not good for patient care," another colleague warned.
An Unsustainable, Unfair System
Not only is this system unsustainable for our nation's physicians, but it's also unfairly stacked against them.
It's the same system that concurrently hospital-based clinics more for some of the same services an independent, provides. On top of that, Medicare helps hospitals cover uncompensated care.
I'm not saying hospitals don't deserve to be paid for what they do. But when independent physician practices get swallowed up by a hospital or bought out by another entity just to survive, the cost of care can go up, creating ripple effects on our economy. This kind of rapid consolidation is now rampant in our healthcare system, in part because of payment incentives like those in Medicare.
"Our practice is already shutting its clinic doors as we instead focus on being a purely hospital-based practice due to already meager reimbursement," another worried Texas physician shared with TMA. "We simply cannot afford the overhead. Ongoing cuts to [Medicare] physician reimbursement not only hurt us -- the physicians trying to provide the best quality care to our patients -- but it ultimately hurts the patients and their loved ones suffering from life-altering conditions."
"I barely scrape through making payrolls every pay period. Any more [Medicare] reimbursement [cuts are] going to put me and thousands of physicians like me under water and force us to shut down or join [a private] equity company or [insurer-owned] clinics who put their wallets ahead of patient care," said another frustrated physician.
We should be preserving independent medicine and patient choice -- not undermining it. It's time for Congress to address the root of the problem.
Solutions
The first simple step physicians and other healthcare professionals can take is to advocate for Congress to enact laws directed at paying physicians fairly for services provided to Medicare patients. At a minimum, that entails pay that keeps pace with inflation. Just like other industries' labor costs are tied to the Consumer Price Index (CPI), Medicare physician payments should at least be tied to a similar measure of physician practice cost inflation, the Medicare Economic Index (MEI).
Several physician members of Congress are leading the charge on such a reform with a bipartisan that behooves support: H.R. 2474, the Strengthening Medicare for Patients and Providers Act. The centerpiece of that legislation is an annual, inflation-based Medicare physician payment update based on the full MEI.
Our current predicament is tied to the fact that Medicare physician payments haven't even come close to keeping up with inflation over more than 20 years. Since 2001, Medicare physician payments have lagged 26% behind inflation while hospital and other health industry payments have kept pace, according to American Medical Association . Over the same period, the CPI for physician services in U.S. cities .
Just think about that: What would you say if you worked more than 20 years with no raise and pay cuts to boot? I know what my colleagues across Texas are saying:
"If [another cut is] enacted, our [Medicare] reimbursement rate will be lower than what we received in 2012," one physician calculated.
Another said, "My Medicare reimbursement, factoring for inflation, is less than half of what it was in 1998."
The frustration is real, and so is the effect of Medicare payment cuts on physician practice viability. Likewise, access to care concerns for Medicare patients are therefore very real, too.
Don't let a broken Medicare system break the backbone of the healthcare system for our most vulnerable patients.
is a cardiologist and president of the Texas Medical Association.