In the News

OPINION:

Imagine calling your physician’s office for an appointment only to be told your longtime doctor is closing his doors because his practice is no longer sustainable. Shocking? Yes. Based on reality? Again, yes.

Failure to address the nation’s Medicare system and how it pays doctors for the care they provide continues to undermine the viability of medical practices — and that directly affects patients’ access to the health care they need and that doctors want to deliver. 

Doctors’ pay has steadily decreased in recent years as Medicare rates continue to fall below the inflation rate. The federal government’s own data shows that Medicare physician payment has been reduced by a jarring 26% between 2001 and 2023 when adjusted for inflation.

At the same time, doctors are being squeezed by rising medical costs and intrusive administrative burdens. The result of this financial uncertainty? Physicians are facing difficult choices about selling their practices. According to a recent report from the American Medical Association, the share of physicians working in practices partially owned by a hospital or health system increased from 23.4% to 31.3% in the last decade. 

Meanwhile, other physicians are opting to leave medicine altogether, creating shortages that are likely to worsen without serious policy intervention. According to a recent report, the U.S. faces a projected shortage of between 37,800 and 124,000 physicians in the next 12 years.Top Storie00:2301:1        Marjorie Taylor Greeneconfronts Mayorkas with photo of constituents killed at border

By 2034, there will be a shortage of between 17,800 and 48,000 primary care physicians and 21,000 and 77,100 non-primary care physicians. This includes shortages of between 15,800 and 30,200 for surgical specialties, between 3,800 and 13,400 for medical specialties, and between 10,300 and 35,600 for other specialties.

Doctors are concerned by the proposed payment cut and fear they will be unable to absorb the drastic reduction in reimbursement due to increasing expenses. If the proposed cuts are left unresolved, physicians may be forced to make tough decisions on staffing and the services they can offer to their communities.

More cuts will lead to continued shortages and, ultimately, even worse access. Sadly, my home state of Missouri is already confronting this crisis, as nearly every county is designated as a “Healthcare Professional Shortage Area.” Older Americans, especially those in rural areas, shouldn’t lose access to health care due to a broken Medicare system.

That is why Congress must act to ensure that Medicare’s reimbursement reflects the cost of delivering high-quality care to patients.

A bipartisan bill presented to Congress that reforms Medicare would be the most effective solution to this problem. To work toward a solution, Congress must establish a permanent, annual inflationary Medicare physician payment update that keeps up with the cost of practicing medicine and encourages practice innovation.

Budget neutrality policies need to be revised to prevent erroneous utilization estimates from causing inappropriate cuts, clarify types of services that should or should not be subject to budget neutrality adjustment, and raise the projected expenditure threshold that has been in place since 1992.

To help address this issue, four physicians who serve in Congress — Reps. Larry Bucshon, Indiana Republican; Mariannette Miller-Meeks, Iowa Republican; Raul Ruiz, California Democrat and Ami Bera, California Democrat — recently introduced the bipartisan Strengthening Medicare for Patients and Providers Act. Doctors have reason to hope that this legislative effort could put Congress on the path to finally reforming the outdated Medicare payment system.

Overall, the payment system remains unsustainable, threatening beneficiaries’ physician access. With real pay for physicians drastically dropping over the last two decades, it is increasingly difficult for doctor’s offices to stay afloat.

The Medicare physician payment system should include an adequate annual physician payment update, just like those that apply to other Medicare provider payments, such as hospitals. Working toward a bipartisan solution for beneficiaries requires the assistance of Congress to help keep America’s health care system strong.

I encourage our leaders in Congress to support the Strengthening Medicare for Patients and Providers Act so that older Americans can continue to access the care they need close to home.

• Dr. George J. Hruza is the medical director of the Laser & Dermatologic Surgery Center in St. Louis.