'Our healthcare system is a travesty': Physicians fed up with CMS' proposed pay cuts

CMS suggested a 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024, which was released July 13.

Eight physicians connected with Becker's to chime in with their thoughts on the proposed pay cut. 

Note: These responses have been lightly edited for length and clarity.

Stephen Amann, MD. Gastroenterologist at Digestive Health Specialists (Tupelo, Miss.): Unfortunately, CMS continues to focus on cuts to the front-line providers for Medicare recipients. I am certainly cognizant of the general financial pressure on CMS and Medicare, but fulfilling their promises on the back of the providers is problematic. These cuts continue to undermine physician practice's ability to provide access and care to the Medicare population. Physician service payments have not come close to keeping up with inflation for years. Indeed, physician payments via Medicare are one of the only areas in Medicare payment models that does not have inflationary adjustments and has had frequent cuts.The staff, equipment and supplies we have in an office practice have continued to go up and are affected by inflation as is everything generally in society.  

My biggest concern over time is that this will begin to erode access for Medicare recipients to find physicians who will continue to accept new patients or will limit the number of patients from Medicare that they will see. The financial strain on practices will erode development of new services, expansion of care and may influence decisions to join an employment type of practice. 

Physicians in private practice, despite these cuts, over time have generally improved and expanded the number of patients they serve and take care of due to diligent work, efficiency and innovation. Unfortunately, these financial constraints may ultimately negatively impact our ability to continue to practice as we know it.

Jan Duncan, MD. Orthopedic Surgeon at California Spine (Los Angeles): There is a shortage of doctors and inflation occurring. All of this means that doctors pay should increase and not decrease. All of our contracts with HMOs pay at a higher percent than Medicare. Sooner or later most doctors will refuse Medicare. The only advantage of Medicare is that there is no authorization needed for treatment.

Maynard Ewton, MD. Physician, Physician Development at Texas Health Physicians Group: An unfortunate decision that ultimately penalizes the Medicare patient. Are there other federal programs that propose pay cuts?

Arunab Mehta, MD. Assistant Professor of Clinical in the Department of Internal Medicine at the University of Cincinnati: These are my personal views and not of my organization or place of work.

The CMS proposed fee schedule proposing a cut in the conversion factor by 3.34 percent seems extremely discouraging for all physicians/providers. Physician practices and hospitals are already struggling financially in 2022 and 2023. 

Physicians have gone through a few stressful years related to the pandemic, have high levels of student loans due to expensive medical education and come out of training in their mid-thirties and have pay go down over 26 percent in the last two decades, making things extremely difficult.

For patients, this will worsen access to care, since some physician practices will begin rejecting patients with Medicare if reimbursement keeps falling, and there will not be enough providers to see the rising proportion of the population that is aging.

For the field of medicine, with payments coming down over the years, the field of medicine will become a less attractive option for the population in general, and the American population will suffer by not getting the most qualified individuals in the population going into the field of medicine as they do now. Those individuals will likely pursue other fields that tend to be more lucrative.

Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): Continuing to cut physician fee schedule rates drives clinical care across the country towards system-based healthcare. It's difficult to name another profession that is faced with compensation cuts multiple times a year. Even physician assistants and nurse practitioners are impacted by the 85 percent rule from Medicare.

These cuts are even more discouraging after physicians and healthcare professionals have spent more than two years continuing to provide patient care during a global pandemic. It seems as though physicians are routinely facing compensation cuts, as if to say physician reimbursements are the reason why healthcare costs continue to rise.

But, it is important to remember that there are other important changes on the horizon, such as CMS' plan to extend telehealth coverage and the scope of telehealth originating sites. Further, the expansion of integrated mental health services in the primary care setting has been extremely beneficial to patient care. The addition of new billing "G" codes for chronic pain patients, caregiver training services, health and wellness coaching, illness navigation, community health integration and care coordination are all on the horizon. While these are all positives, it is important for physicians and other providers to stay up to date on new billing codes and added services in order to actually benefit from them.

Many physicians are now re-thinking the aspects of their role in healthcare, from discussion of employment benefits (unions/noncompetes), shifting to a model of direct primary care services, and integrating research and/or policy into clinical practice. While these changes may affect the outlook of physician careers, the long-term effects on physician well-being and patient outcomes, both financial and medical, remain unclear.

Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: People wonder why our healthcare system is in such a turmoil. Poor access to doctors, and emergency rooms are so overcrowded with trivial problems. Who wants to go into medicine when your reimbursement goes down every year? I pay more for my plumber or electrician than I make per hour. Also, the restrictions are becoming unbearable. And don't forget the underlying fear of malpractice. Our healthcare system is a travesty, and I have to blame much of it on the government. Big business is running medicine and that's a shame.

Issada Thongtrangan, MD. Orthopedic and Neurological Spine Surgeon at MicroSpine (Scottsdale, Ariz.): I think I am getting used to it. The reimbursement and conversion factor have been slashed continuously each year despite the amount of paperwork that the doctors and practice must comply with. In addition, this causes a lot of burden on the practices to be able to deliver quality care with low reimbursement and increasing expenses. I am not aware of any evidence that slashing the reimbursement or conversion factor will improve patients' outcomes. I just have to adapt and try to cut the expenses without interfering with my patients' care.

James Tinsley, MD. Family Physician at Lighthouse Direct Primary Care (Newport News, Va.): As a family physician I went under twice with high enrollments of Medicare patients and had to leave the practices with outrageous noncompetes. Once with a 35 percent Medicare empanelment and the other with a 55 percent empanelment. If you have an older car, it costs more to repair because there is more wrong with it and the mechanics have to spend more time repairing the older car. So why aren't MDs paid more to care for the elderly? My children can no longer afford for me to accept Medicare, so I opted out.

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