The Medicare Payment Advisory Commission, (MedPAC), voted unanimously in favor of a recommendation that no changes be made to the physician fee schedule for the fiscal year 2023. This prompted immediate protest from the American Medical Association and other medical associations.
A combination of inflation plus lost revenue during the COVID-19 pandemic sparked concern. According to current law, there has been no increase in the base rate of physicians’ payment in 2023..
In 2020, Medicare paid $64.8 billion to 1.3 million clinicians, reflecting an $8.7 billion drop from 2019. The technical staff of the commission noted that clinicians have received “tens to billions of dollars in pandemic relief funds” from programs like the Provider Relief Fund , and the Paycheck Security Program .. This represents an $8.7 billion drop from 2019.
CMS significantly increased Medicare payment rates to E&M offices and outpatient visits in 2021.. In spite of the pandemic, doctors’ overall compensation actually rose from 2019 up to 2020.
Dr. Jim Matthews of MedPAC said that the commission takes its responsibility to evaluate payment adequacy and uses the best available data. “We try to make a determination based on cold facts.” “
“Regarding physicians, we can see that the preponderances of our payment adequacy indicator on an objective basis does not indicate that there is an immediate problem with Medicare payments in aggregate. Matthews said. The commission is not blind to the environment. We fully understand and sympathize with what has happened in the clinic community to deal with the pandemic over two years. “
” These decisions are not taken lightly or on-the-fly,” and although stakeholders may have concerns about the data used or eventual decisions made by the commission, “everything we do is in the best interests of Medicare program beneficiaries and tax payers who support the program.” “
Medicare payments per beneficiaries fell in 2020, but then rebounded and the Medicare Economic Indice (MEI), is expected to rise 1.8% in 2023. However, MedPAC’s technical staff pointed out that there was a steady supply of clinicians and beneficiaries had similar care experiences to those with private insurance.
” When we look at beneficiary usage of services, we see that the decline we saw in 2020 is clearly a result of the pandemic of in spring and June of . By June, utilization of services had bounced back to pre-pandemic levels,” Matthews stated.
As for physician participation, the “vast majority of physicians” continue to accept Medicare payments and participate in Medicare programs. Matthews says this indicates that Medicare payments are sufficient to provide care access.
Finally, MedPAC conducts a survey every year to determine beneficiary access. It asks beneficiaries whether they have been without health care, if they were in a position to receive timely appointments and if they are able to find a doctor if they need one. Matthews stated that this is to assess the level of access to medical care.
” We continue to find that Medicare beneficiaries report high degrees of satisfaction with the care they receive,” he stated.
There are still access issues for beneficiaries in finding primary care doctors. This is more than the problem of specialists. However, Matthews said that the commission is working to solve this long-standing problem.
CMS will announce this summer its updated payment rates.
Physicians, Medical Groups Fired Up
In a press release, Gerald Harmon, MD, president of AMA, stated that the recommendation “imperils patient accessibility to high-quality care as costs to practice medicine continue rising.” “
After adjusting for inflation in practice costs, physician payment under Medicare fell 20% from 2001 to 2020, according to the AMA. Harmon stated that the gap in payment and costs of running a practice have increased consolidation, which has led to physicians fleeing rural areas and underserved regions.
One in five physicians are now considering leaving pra