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Opinion: Under new Medicare rule, rural seniors are at risk

The mission of the Missouri Rural Health Association (MRHA) is to provide leadership on rural priorities through advocacy, partnerships, and education. Our goal is to elevate the voices of rural Missourians to improve health and well-being.

Rural health care is in a state of crisis throughout the United States. Access to high quality healthcare is on the decline for rural Americans as rural hospitals continue to close at an alarming rate and more physicians seek greener pastures in more densely populated areas.

Medicare beneficiaries, our nation’s seniors, are on the precipice of a healthcare crisis, as cuts to Medicare reimbursements in 2024 loom large. Without permanent reform, healthcare for seniors will be compromised in several alarming ways.

The Centers for Medicare & Medicaid Services (CMS) have finalized a 3.4% cut in pay under the 2024 Medicare physician payment schedule. Any reduction in physician payments threatens to undermine the very foundation of the Medicare program, jeopardizing the relationship between seniors and their doctors, which is built on trust and access to quality care.

What makes the situation even more dire is the absence of an annual inflationary update for physicians. Unlike other healthcare providers, physicians do not receive automatic annual adjustments to their Medicare payments to account for inflation. In a time of persistent inflation compounded by the residual impact of the pandemic on the healthcare industry, this statutory oversight amplifies the devastating effect of the proposed payment cuts.

Physicians, who are already facing a significant financial burden, cannot afford to operate under the current payment system. The cost of running a medical practice has surged by 39% from 2001 to 2020, a fact highlighted in a report by Leigh Page titled “Physicians’ Medicare Pay Keeps Dwindling.” Furthermore, an analysis by the American Medical Association shows that Medicare physician payment has been slashed by 26% when adjusted for inflation from 2001 to 2023.

In stark contrast, other healthcare providers have seen significant payment increases. Payments for skilled nursing facilities, inpatient hospital visits, and outpatient hospital visits have risen by around 60% since 2001, while physician payments have only increased slightly more than 10%. The system is disproportionately disadvantaging physicians, the very backbone of the healthcare system, who are at the forefront of patient care.

In 2023, all healthcare providers received Medicare payment updates, except physicians. This discrepancy is both unjust and detrimental to the sustainability of medical practices. It’s no surprise that many physicians are suffering from burnout, stress, and an overwhelming workload. The cumulative impact of the COVID-19 pandemic has exacerbated these challenges, leading one in five physicians to contemplate leaving their current practice within the next two years. If these physicians depart, it will further reduce the access to care for seniors.

For the long-term sustainability of our healthcare system, Congress must take decisive action to reform the Medicare physician payment system. Reforms should aim to simplify the system, make it more reflective of real-world physician practice costs, and ensure predictability for both physicians and CMS. Urgent steps are required to address the impending crisis:

Congress should prioritize the passage of H.R. 2474, also known as “the Strengthening Medicare for Patients and Providers Act.” This legislation proposes applying a permanent inflation-based update to the Medicare Physician Fee Schedule (MPFS) conversion factor. Such an update is crucial to providing stability to the Medicare payment system.

The time for action is now. Congress cannot afford to delay these critical steps any longer. Protecting seniors’ access to physician care is not just a matter of fiscal responsibility but also a moral imperative. Our nation’s seniors deserve quality healthcare, and it is our duty to ensure that they receive it without compromise.