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Opinion: Congress needs to reform Medicare, before it is too late

Across the U.S., physicians who treat patients with Medicare are being forced to do more with less. Congress has allowed this situation to worsen to the point where I worry some Missouri patients, especially those in rural communities, will begin to lose access to a physician’s care. 

If Congress doesn’t act soon, Medicare could cut payments to physicians by 8.42%. There are three reasons why this drastic cut is happening now. 

First, CMS is proposing a 4.42% reduction in payments. Considering CMS is level funding or even increasing payments for skilled nurses and in- and outpatient visits, these cuts to doctors makes no sense at all. 

Second, Medicare does not consider inflation or the real costs of running a practice when it determines its payment schedule to physicians.  

Finally, Congress’s budget neutrality rules force a 4% cut across the board when government spending gets too high. Well guess what? Washington’s spending is too high, and these budget rules will kick in next year. I generally favor measures that incentivize spending restraint, but does anyone believe spending on health access for our older neighbors should be subjected to the same cuts as, say, defense contractors? 

To compound the problem, consider the fact that the current inflation rate remains exceptionally high at 8.3% and we are currently experiencing the worst sustained inflation crisis since the early 1980s. The cost of running a physician practice has increased almost 40% in the last 20 years. When costs go up and payments keep shrinking, patients lose because over time fewer physicians are available to treat patients with Medicare.  

As noted, Congress has traditionally averted a crisis by temporarily suspending some of these cuts. But it’s time for a permanent solution. 

As a first step, Congress needs to pass new legislation to stop the 4.42% cuts from kicking in in January 2023. But this would merely stop the bleeding. Congress should, at the same time, increase payments to physicians commensurate with other providers’ increases. 

Then, Congress must set about the work of passing long-term fundamental reform of Medicare’s physician payment system. Baseline annual adjustments should be pegged to inflation and investments should be made to incentivize value-based care. Budget neutrality provisions should protect, not punish, systems that have seen little or no spending growth, like physician payments. Better yet, eliminate them altogether. 

Rep. Jason Smith (MO-08) should take the lead on these reform measures. His district is predominantly rural, and the folks he represents would be disproportionately affected by shortage of physicians who care for Medicare beneficiaries. Moreover, he’s shown repeatedly that the care of seniors in his district are of paramount importance to him.

Americans have endured a lot of health scares over the past couple of years. But there would be nothing scarier than having zero access to a quality physician because Congress lacked the will to fix the way Medicare pays doctors. 

Let’s get it done for the people of Missouri.