Under new rules, doctors are confronted with a potential reduction in Medicare payments
Medical groups argue that the changes will force their members to reduce access to care for Medicare patients.
The federal government is moving forward with an agenda to set Medicare reimbursement rates for physicians and hospitals next year despite pushback from industry groups.
The decrease, which is in line with the initial proposal this summer, also amounts to a $1.8 billion reduction in funding for doctors, according to CMS.
Conversely, hospital outpatient departments and ambulatory surgery centers will see a 2.9 percent increase in Medicare rates, slightly higher than the initially proposed 2.6 percent. CMS estimates the new rates will provide hospitals with an additional $2.2 billion in funding for the upcoming year.
The changes have sparked strong opposition from healthcare groups.
Bruce Scott, president of the American Medical Association (AMA) and a practicing otolaryngologist, criticized the cuts. He pointed out that while physicians are facing a 2.8 percent cut in reimbursement, the cost of providing care to Medicare patients is expected to rise by 3.5 percent.
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“You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” Scott continued. “For physician practices operating on small margins already, this means it is harder to acquire new equipment, harder to retain staff, harder to take on new Medicare patients, and harder to keep the doors open, particularly in rural and underserved areas.”
The American Medical Group Association (AMGA), which represents some 400 medical groups and health systems, echoed these concerns. Citing a recent survey, the trade group warned that its members might have to cut staff and reduce access to care for Medicare patients in order to survive.
Hospitals and clinics are also unsatisfied with the 2.9 percent increase, which they say fails to keep pace with rising operational costs.
The American Hospital Association (AHA), an influential healthcare lobby, argued the rates will make it harder for hospitals to invest in patient care, expand their workforce, and address new challenges like cybersecurity threats.
There are some changes that healthcare groups cheered, particularly those related to the Medicare Shared Savings Program, which offer financial incentives for providers to lower growth in healthcare costs for medicare patients.
According to the CMS, providers with a history of success in the program can get an advance on those funds from the government to invest into staffing, care, or infrastructure. The new rule also adjusts the benchmark for providers that serve more patients from rural and underserved communities, encouraging more participation and retention in the program.
The U.S. Department of Health and Human Services didn’t immediately respond to a request for comments.
