Opinion, WVPA Sharing

Opinion: Physicians facing massive Medicare cuts, need Congress to Act

By Dr. Tom Takubo

Charleston, W.Va.

Anyone reading or watching the news in America knows that Congress is grappling with increasingly divergent opinions on what is right for this nation. For those of us in West Virginia, we are grateful to have U.S. Sen. Joe Manchin holding the line against unfettered new spending.

Dr. Tom Takubo

As much as Senator Manchin has on his plate right now, I’m boldly going to ask him to add one more issue.

Physicians in the United States have an impending fiscal cliff that needs immediate intervention. They are facing massive cuts from the Medicare program in less than two months. The American Medical Association has been ringing the alarm bell for a while, and I am adding my voice to this effort to urge Congress to act.

The details behind the cuts are complicated, but all told, physician practices face a 9.75 percent Medicare pay cut starting Jan. 1, explained as follows:

  • In 2013, a 2 percent cut in Medicare reimbursements to physicians was instituted as part of the budget sequestration effort that required across-the-board cuts to government programs. Those cuts were frozen but are set to come back starting in 2022.
  • The 2021 American Rescue Plan Act created a 4 percent cut to Medicare in what is called PAYGO, which is another kind of sequester used as a mechanism to offset large increases in the federal deficit. This means the Biden Administration is paying for infrastructure spending by slashing payments to doctors.
  • The third issue is a change in the evaluation and management codes from the Centers for Medicare & Medicaid Services (CMS). CMS can change what it pays for services without Congressional approval so long as the changes are revenue neutral. When CMS decided to make significant increases in payments for office and outpatient evaluation and management services starting this year, they paid for it by making a 3.75 percent cut to physicians starting January 1.

We need Congress to step in and prevent all these cuts from taking effect in a matter of weeks.

Like other businesses, doctors are just starting to recover from the COVID-19 pandemic.

During the pandemic, doctors’ offices saw in-patient visits drop by a third. One in five physician practices across the country experienced dramatic revenue dips of 50 percent or more, and eight in 10 physicians still have not seen revenues return to pre-pandemic levels, according to an AMA survey of its members.

Physician practices are businesses that employ a wide variety of health care workers, so low revenues affect staffing and services, which affects patients. Let’s remember that physicians by and large cannot control their pricing – they only get paid what private insurance companies and government-run programs are willing to pay. And by and large, government-run insurance reimburses providers at lower rates than private insurers.

In West Virginia, government-run insurance makes up a large portion of our patient base. More than 440,000 West Virginians — one-quarter of our state population — are on Medicare, so a 9.75 percent cut in Medicare reimbursements will devastate physician practices.

The AMA is urging Congress to pass legislation to prevent the fiscal cliff awaiting on January 1. We also want Congress to hold hearings on how to improve the Medicare physician payment system permanently, because we seem to be in a never-ending loop of impending cuts that require Congress to step in.

Meaningful Medicare payment reform should include annual updates that accurately reflect the increased year-to-year cost of providing services. Medicare payments to facilities (like hospitals) receive inflationary updates each year, but not physician payments.

I am asking the entire West Virginia Congressional delegation — especially Senator Manchin — to step in and help physicians keep their doors open. The world continues to grapple with a global health care crisis caused by COVID-19, and now is not the time for the federal government to shift resources away from doctors.

Dr. Tom Takubo is a Charleston-area pulmonologist and majority leader of the West Virginia Senate.

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