GUEST COLUMN: Congress must fix Medicare

Even as the healthcare system continues to navigate its way out of a global pandemic, there is a perfect storm looming for the Medicare program that, if left unchecked, threatens access to physicians for millions of vulnerable and underserved Americans. 

Physician payment cuts, lack of inflationary updates, and unnecessary administrative burdens threaten physicians’ ability to serve Medicare patients, and only immediate congressional action can help avert unnecessary disruptions in care.

More than 63 million Americans participate in the Medicare program, which enjoys broad bipartisan support. For more than 50 years, Medicare has ensured seniors and people with disabilities access vital medical care. When Americans — such as those living in areas where there are physician shortages or those subject to market consolidation — cannot access physician care through the Medicare program, it negatively affects their health outcomes, quality of life and life expectancy. The average life expectancy of Americans fell precipitously in 2020 and 2021, the sharpest two-year decline in nearly 100 years. Now is a time when Americans need more care, not less.

The economics of Medicare and the associated administrative burden is already making physician participation in the program difficult. Current Medicare reimbursement rates — the amount physicians receive for treating patients under the program — do not adequately compensate them for treatments and care. According to an American Medical Association analysis of Medicare Trustees data, from 2001 to 2021, Medicare physician payments have been reduced by 20 percent when adjusted for inflation. Neglect like this has consequences.

Medicare rate decreases have been compounded in recent years by budget neutrality-related changes to the fee schedule, which Congress mandated in 1983. This law says physician fee changes cannot increase or decrease federal expenditures by more than $20 million annually. Congress has passed legislation in the last two years to avert these and other cuts, but relying on recurring annual legislative fixes is untenable.

When Congress and the administration should increase reimbursement rates to match inflation, policymakers appear poised to do the opposite. Cuts would aggravate a dire shortage of participating Medicare physicians across the country. If physicians are forced out of the Medicare program, it is rural and underserved communities — areas where there are only one or two participating physicians — who will disproportionately bear the burden. People of color and low-income Americans will be hurt the most.

Interventional cardiologists know the effect when patients lose access to care. Heart disease is the No. 1 killer of Americans. During the COVID-19 pandemic, many Americans canceled appointments or delayed care, but patients cannot afford to ignore their heart health.

As we continue to grapple with the effect of COVID-19, policymakers must act to prevent a seismic disruption of care for Medicare patients. Fortunately, there are potential legislative solutions currently under consideration. The Supporting Medicare Providers Act of 2022 is bipartisan legislation that will prevent the scheduled 4.5 percent Medicare payment reduction from going into effect in January 2023. A second bipartisan bill, the Medicare Stability for Patients and Providers Act, would correct the implementation of Medicare’s clinical labor formula. Together, these two laws would address the immediate threats to Medicare.

I urge Congress to pass these acts to protect access to high-quality health care for seniors and help put Medicare back on a responsible and sustainable path.

Lyndon Box is a cardiologist and Government Relations Committee chair for the Society for Cardiovascular Angiography and Interventions. He wrote this for InsideSources.com.