'Patients will suffer': Physicians talk impact of potential CMS pay cut

Physicians are bewildered and concerned about the CMS proposal to cut physician pay by 4.42 percent in its Medicare physician fee schedule proposal for 2023. 

Nine physicians spoke with Becker's about how the cut would affect them as well as patients. 

Question: If CMS follows through with its proposed 4.42 percent physician pay cut, how will physicians & patients be affected?

Editor's note: These responses were edited lightly for clarity and length. 

Cory Calendine, MD. Orthopedic surgeon at the Bone and Joint Institute of Tennessee (Franklin): Physicians, those standing closest to the patient and essential for patient care, are facing incredible inflationary pressure in the maintenance of their practices and offices. They have increasing staff and supply costs which are making continued viability more difficult. Larger economic factors are contributing to this inflationary pressure, but the COVID-19 effect is undeniable. To be facing these rising costs (aka rising "overhead"), and then to have the largest governmental payer suggest a reduction in reimbursement is seemingly tone deaf to the physician ecosystem and its current difficulties. Without physicians, we will not have coordinated patient care. Patients will suffer.

Matt Mazurek, MD. Assistant professor of clinical anesthesiology at Yale School of Medicine (New Haven, Conn.): Patients will have fewer options as physicians will choose to retire earlier or close practices in areas or regions where there is an unfavorable payer mix. The current economic environment has produced the ‘perfect storm’ for this to occur, as inflation has dramatically increased labor costs and overhead for all healthcare providers. Rural providers and patients will be especially hard hit by these cuts, as patients in these regions rely heavily on both Medicaid and Medicare for care. Reduced payments will make recruitment and retention difficult, and CMS is placing barriers on its own initiatives to improve access to care through these cuts. In summary, these cuts will exacerbate the shortage of physicians and lack of access to care.

Bradley Shapiro, MD. Gastroenterology physician at Duly Health and Care (Hoffman Estates, Ill.): The proposed 4.42 percent pay cut for physicians is appalling and shows lack of appreciation for our profession. Soaring inflation results in increased overhead, including labor and supplies vital to running a medical practice. I anticipate this will lead to closures of smaller medical practices, as they will not be able to absorb the increasing costs due to decreasing revenues. Some internal medicine physicians will likely turn to concierge medicine in order to enhance revenue. As Medicare puts the squeeze on physicians, many will retire earlier than expected, decreasing availability for patients. More than 43 percent of the physician workforce is 55 and older. These changes will result in physician shortages and decreased access to care for our patients, especially in the primary care setting. I can only hope our medical societies can adequately express these concerns to Congress and amend these proposed changes.

Gerald Hayken, MD. Orthopedic surgery specialist in Mount Laurel, N.J.: I believe that the 4.42 percent CMS pay cut is damaging to the healthcare system. I believe that it will drive more physicians out of private practice, a trend that is already underway. In a world of escalating costs and increasing regulation, it is becoming too difficult to practice medicine, not because we don't enjoy patient care, but because it is becoming too difficult to provide good patient care and also make an appropriate living for the care and benefits that we provide. 

As more physicians move to hospital and large-group employment, costs will rise because these cost centers get reimbursed for care at a higher rate than physicians in private practice.  Additionally, access to care for Medicare patients will be reduced due to poor reimbursement. Many young people considering careers as physicians will be discouraged by the high costs of education, frequently resulting in huge amounts of debt and limited financial rewards. Older physicians, who can afford to, will retire at an earlier age. I believe that the healthcare industry has to be reformed. We need a system that will ensure that all people have access to care. I also believe that physicians should be freed from the burdens of unnecessary bureaucracy. 

Shamsideen Musa, MD. Pain management physician in Anchorage, Alaska: If the 4.42 percent physician pay cut moves forward, it will further decrease patient access to specialty care. Initially, patients with Medicare as their primary insurance will have difficulty finding specialists with available appointments for new patients. This will then progress to all patients, as commercial insurers change their reimbursement policy to fall in line with CMS rates. Ultimately, this will continue to drive physicians away from solo practice toward large group practices that leverage economies of scale and care team models using physician assistants and nurse practitioners to handle the higher volume of patients necessary to be profitable. 

Joseph Inglefield, MD. ENT at Hickory Allergy & Asthma Clinic & Cough Center (Hickory, N.C.): I think that banging pots and pans for healthcare workers like physicians and nurses is not enough. So much for healthcare heroes. Just remember that our labor, materials, business expenses, health insurance [up about 10 percent for renewal]. Malpractice insurance and rent have all gone up dramatically. Inflation is now at 9 percent. The proposal is to decrease pay, essentially an approximate 15 percent result in a decline. As we struggle with extensive paperwork for [Paycheck Protection Program] loans and forgiveness, having accounting firms charging 10 percent fees for those reimbursements, it is no wonder practices are selling out, and those close to retirement, who wish to continue working, are all reconsidering leaving medicine. The cost of living and practicing in the wake of inflation portends a negative future for those of us in solo private practice. Insurance companies continue to delay preauthorization and reimbursement with increasing denials and foot-dragging. Big Pharma makes it difficult to treat our patients with an unsustainable increase in the cost of the medications, which adds to the stress of using often inadequate treatments with dissatisfied patients or disgruntled staff. Physicians are expected to just absorb more than their share of this type of abuse. 

Scott Huitink, MD. Pediatrician and owner of Compass Pediatrics (Nashville, Tenn.): This will further the move for physicians to go to direct patient care. Patients will be directly required to pay a monthly fee. Insurance payments and hassles will be avoided.

Jonathan Phillips, MD. Former orthopedic surgeon at Orlando (Fla.) Health: I recently retired at the age of 62. There were many reasons, but the most important was a decrease in salary of 10 percent over a two-year period as a result of a contract renegotiation with my employer. A decrease of 4.4 percent by CMS will effectively be a greater than 10 percent salary loss in real terms, given 8 percent inflation. We only have to look at the recent spike of resignations by senior physicians in the United States to predict what’s going to happen. We are already looking at a shortage of thousands of doctors over the next several years, and this will exacerbate the problem hugely. Access to timely healthcare in the United States will be severely harmed, and patients will suffer. I am one of those patients now, and I’m concerned for the future of my own healthcare.

It’s inconceivable to me that anyone within administration at CMS would accept a 4.4 percent  pay cut. It just does not happen.The same goes for hospital administrators who increasingly expect physicians to work longer hours for less money so they can profit from our efforts. There is a parallel in the nursing profession, and we have seen the wave of resignations and retirements here, too. 

Michael Pech, MD. OB-GYN at Gundersen Health System (Mausten, Wis.): I turn 61 next week. I was planning on working until 65, but if reimbursements continue to decline, I will retire earlier. I am practicing because I still enjoy it, and my skills [I believe] remain high. But if the government continues to screw with physicians, I will just hang it up and enjoy my retirement.

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