The Medicare Payment Advisory Commission (MedPAC) issued its latest report to Congress on March 15. Their opinion was simple and direct — Medicare payments don’t need to be increased in 2023. Their report stated, “Overall, access to clinician services for Medicare beneficiaries appears stable and comparable to that for privately insured individuals.” And they continued by saying, “We expect volume and revenue to return to pre-pandemic levels (or higher) by 2023. Therefore, the commission does not see a reason to diverge from the current-law policy of no update for 2023.”
However, access to and quality of care during the pandemic has been problematic. Many Medicare recipients were frightened to venture out of their homes for medical care unless they believed it was an emergency that couldn’t wait. Cancer screenings and cardiac/vascular screenings, including echocardiograms and peripheral artery disease testing, declined significantly during the pandemic — particularly impacting Medicare recipients.
MedPAC executive director James Mathews, PhD contends that among the physicians who accept Medicare, “the vast, vast majority take Medicare payments in full on assignment.” During the March 15 press conference, “So those indicators, imperfect as they may be, do suggest that in the aggregate, Medicare payments to physicians and other clinicians are sufficient to ensure access.”
Medical Groups Fire Back
The American Medical Association (AMA) immediately replied to Congress with a letter cautioning Congressional leaders that the MedPAC recommendations would place Medicare recipients at risk of decreased access to quality healthcare. They were quick to remind members of Congress that Medicare physician fee schedule spending declined by 13.8 billion dollars in 2020 because of patients delaying visits due to the COVID pandemic. When adjusted for inflation, the AMA letter reiterated that physician payments have declined by 20% from 2001 to 2021. That percentage does not consider the new spike in inflation that the U.S. is currently experiencing.
The AMA urged Congress to implement solutions to address the “systematic problems with the Medicare physician payment system and preserve patient access to care.” More physicians are considering leaving their practice now than at any other time in recent history — citing workload, burnout, stress, and fear of COVID infection.
The Medical Group Management Association (MGMA) countered back, citing physicians are facing the highest inflation rates in 40 years, and on April 1, the 2% Medicare sequester cuts will begin again. And as MGMA reminds us that physicians are “still reeling from pandemic-related disruptions, rampant staffing shortages, and skyrocketing expenses.”
Anders Gilberg, senior VP of government affairs for the association, suggests that serious consequences will result from no adjustment for 2023. Without adjusting for inflation, the consequences will force some practices to make difficult decisions about Medicare participation, potentially limiting access for vulnerable populations. Suggestions include a permanent repeal of the 2% sequester and an update to account for the real inflation in 2023.