By Fraser Cobbe

As the calendar turns to Autumn, physicians are once again staring down the barrel of significant decreases in Medicare reimbursement due to take effect in January. The annual exercise that was supposed to end with the elimination of the Sustainable Growth Rate, has ended in name only. The same flawed and unsustainable approach to setting physician reimbursement in Medicare in a budget-neutral vice remains. Evidence continues to mount of the dramatic implications that this flawed approach has had on care delivery and provides justification for fundamental reform in how our nation funds access to care for Medicare beneficiaries.

Since the release of the draft Physician Fee Schedule (PFS) over the summer, organized medicine has been unified in seeking relief from the Centers for Medicare & Medicaid Services (CMS) and from Congress on the devastating impact these cuts will have. The proposed cuts, ranging from 10% to 20% depending on the specialty, would be drastic in any year. They are even more devasting this year given the multi-factorial impact of the COVID-19 pandemic on physician practice which includes: increased practice expenses to protect patients and staff; the shutdown of elective procedures; inflationary impact on the cost of supplies; and workforce shortages that are driving up employment costs. Simply put, the clock is ticking on Congress to act to save access to community-based care for Medicare beneficiaries.

Where are the cuts coming from?

Below is a breakdown of how these proposed reductions are being generated.

• E/M Outpatient Codes (-3.75%)

• Sequester Payment Cuts (-2%)

• Pay-As-You-Go Payment Cuts (PAYGO) (-4%)

In addition to these cuts, some organizations, like the American College of Radiation Oncology (ACRO), are highlighting the implications of CMS moving forward with clinical labor data updates in the 2022 Physician Fee Schedule which could cause additional cuts to certain specialties as much as 14%.

There are many physicians that believe Medicare reimbursement policy has been a major contributing cause to the continued elimination of the private practice of medicine as many physicians have shifted to employment with hospitals, health systems, and the corporate practice of medicine. While there are many factors physicians consider when deciding where to practice, there can be no question that declining reimbursement and uncertainty continue to add pressure to private practice medicine.

While immediate action from Congress to prevent the proposed cuts in 2022 is critically important and once again likely, it is time for CMS and Congress to have a broader discussion on the fundamental flaws in the physician fee schedule policy and make reforms that will support access to care for Medicare beneficiaries in the community setting.

Fraser Cobbe, Executive Director, Dade County Medical Association, can be reached at fcobbe@miamimed.com.