It is time for Congress to address the declining life expectancy and access to care in rural parts of Missouri. Health care disparities exist for many reasons, and some of them are hard to address. But there’s one issue threatening rural health care access that our elected leaders could begin meaningfully addressing right this minute: Medicare’s broken physician payment model. And it’s critical that they do because without immediate action in Congress, patients in rural communities will find it even harder to access the care they need.
At the end of last year, the Centers for Medicare and Medicaid Services (CMS) announced reimbursement rates for health care providers in 2025. While payments for nearly all other providers increased, private practice physicians were asked to stomach a 2.83% pay cut. Despite urgent calls from advocates like me for Congress to prevent these cuts from taking effect, they were finalized and implemented starting on January 1 of this year.
It’s important to remember the context for these cuts to physicians’ Medicare reimbursements—physicians trying to run practices are facing the cumulative impact of years of devastating inflation. The medical industry has been hit particularly hard over the years; the cost of running a medical practice has increased more than 50% since 2001. And yet, during that same period, Medicare physician payments have actually gone down by 33% when adjusted for inflation. Simply put, physicians are being asked to make do with less, even as their costs are rising year after year.
The net result is exactly what you’d expect—physicians are under incredible pressure. Medicare’s reimbursement rates are not keeping up with the real world costs of running a practice, and it’s putting physicians in an increasingly untenable position. It’s no surprise then that one survey found that burnout, stress, workload, and post-pandemic factors are leading one in five physicians to consider leaving their current practice within two years.
It’s alarming to think about the consequences for rural communities if nothing is done to address this issue. In all likelihood, more and more physicians will be forced to stop accepting Medicare. This is a particular concern for seniors in rural parts of Missouri who rely on Medicare. The less-urban parts of our state are already at risk for health care provider shortages and declining health care access for residents. Why are we making it even harder to attract and keep great physicians operating in underserved areas by failing to pay them adequately?
There is a solution to all this, but it will not be easy. Congress has failed to adequately address this issue for years, and every year that goes by without action, more damage is done. The reason advocates like me have to keep sounding the alarm on this issue every year is that Medicare’s physician payment model is not automatically updated to keep pace with inflation. Medicare payments for hospice and hospital (inpatient and outpatient) services, are all matched to inflation for 2025—but not physician payments.
With that in mind, the solution comes in two parts. First, we need to “stop the bleeding” by addressing the cuts that went into effect at the start of this year. There is a bill in Congress that will do this: H.R. 879, the “Medicare Patient Access and Practice Stabilization Act.” This legislation stops the 2.83% pay cut and provides a 2% payment update to help stabilize physician practices and protect patients’ access to care. I’m calling on Representative Jason Smith (R-MO-08) to make sure this bill passes as part of the next spending package in Congress.
Beyond that, in the bigger picture, we need call for permanent reform to Medicare’s physician payment model. Instead of “band-aid” solutions every year, we need legislation in Congress that applies a permanent inflation-based update to the Medicare Physician Fee Schedule (MPFS) conversion factor. Otherwise, more and more physicians in rural areas will be forced out of business and advocates like me will continue sounding like broken records as we call for a new fix year in and year out.
Travis Smith is a former State Representative and a true son of the Ozarks. He is a small businessman, high school sports coach, and first-generation farmer who choses to stay and invest in Southern Missouri because he believes in their way of life and the people who live there.
Former State Representative and a true son of the Ozarks. He is a small businessman, high school sports coach, and first-generation farmer who choses to stay and invest in Southern Missouri because he believes in their way of life and the people who live there.
