AMA: Wake up to monetary peril facing Medicare payment procedure

CHICAGO — The American Medical Association (AMA) raised problem now that Congress would seem “indifferent”…

CHICAGO — The American Medical Association (AMA) raised problem now that Congress would seem “indifferent” to the fiscal uncertainty going through the Medicare physician payment technique.

In a letter to congressional leaders, the AMA pointed out that physician methods experience a 9.75 % minimize on January 1. Not only was Congress not taking up laws to reduce this, but proposals are getting floated that intention to wring out far more income from payments to fund an infrastructure package.

“All this money uncertainty arrives at a time when medical professional procedures are however recovering from the financial impression of the COVID-19 general public well being crisis, such as continued infection regulate protocols that, when essential, have amplified the fees of offering care,” the AMA wrote in its letter. “The blend of all these procedures would be challenging to endure in normal periods. Nonetheless, medical professional tactics continue to be stretched to their limitations clinically, emotionally, and fiscally as the pandemic persists properly beyond 15 months. The enactment of additional Medicare payment cuts will undoubtedly threaten individual obtain to treatment, in particular thinking of the stark actuality that, modified for inflation in follow expenses, Medicare medical professional payment actually declined 22 percent from 2001 to 2020, or by 1.3 p.c per year on common.”

The letter urged Congress to move legislation to reduce the fiscal cliff awaiting on January 1 and to hold hearings on how to permanently enhance the Medicare doctor payment program, noting, “The condition of the method is significantly dysfunctional and, ultimately, it will be people who endure.”

The textual content of the letter from AMA CEO James L. Madara, M.D., is under, and a PDF copy can be downloaded below.


Pricey Speaker Pelosi, The vast majority Chief Schumer, Leader McConnell, and Chief McCarthy:

On behalf of the medical doctor and clinical student customers of the American Medical Association (AMA), I am composing to express our deepening alarm concerning the developing fiscal instability of the Medicare medical professional payment method. Not only does Congress appear indifferent to the confluence of fiscal uncertainties confronting medical professional tactics at the finish of this year, but lawmakers’ pursuit of policies to extend the present-day Medicare sequester that, in impact, will demand physicians and health and fitness systems to fork out for tough infrastructure amplifies our ongoing issues.

On January 1, 2022, health practitioner procedures face the adhering to stack of Medicare economical hits:

  • Expiration of the existing reprieve from the regularly prolonged 2 percent sequester stemming from the Spending plan Control Act of 2011.
    • Congress at first scheduled this plan to sunset in 2021 but it will now continue into 2030
  • Imposition of a 4 p.c Statutory PAYGO sequester ensuing from passage of the American Rescue System Act, presumably for at the very least yet another 10 a long time.
    • Should really lawmakers fail to act, it will mark the 1st time that Congress has failed to waive Statutory PAYGO
  • Expiration of the Congressionally enacted 3.75 % short term increase in the Medicare doctor rate program (PFS) conversion aspect to keep away from payment cuts linked with spending plan neutrality adjustments tied to PFS policy adjustments.
  • A statutory freeze in annual Medicare PFS updates below the Medicare Obtain and CHIP Reauthorization Act (MACRA) that is scheduled to final until finally 2026, when updates resume at a price of .25% a yr indefinitely, a figure perfectly beneath the charge of medical or consumer value index inflation.

Mixed, health practitioner techniques confront a 9.75 percent slice on January 1. Also, potential penalties less than the Advantage-Based mostly Incentive Payment Technique (MIPS), which apply to Medicare PFS products and services, will boost to 9 p.c in 2022. All this economical uncertainty arrives at a time when medical doctor techniques are nevertheless recovering from the economical affect of the COVID-19 public health emergency, which include ongoing an infection regulate protocols that, whilst important, have improved the fees of giving treatment. The combination of all these policies would be demanding to endure in standard situations. Nonetheless, health practitioner practices continue to be stretched to their boundaries clinically, emotionally, and economically as the pandemic persists perfectly beyond 15 months. The enactment of further Medicare payment cuts will unquestionably threaten affected person obtain to care, specifically contemplating the stark reality that, altered for inflation in practice costs, Medicare medical professional payment really declined 22 per cent from 2001 to 2020, or by 1.3 % for every year on ordinary.

The AMA proceeds to respectfully request Congress to convene hearings on the alarming condition of the Medicare medical professional payment method, not only from a economic perspective but also associated to a lot of elementary operational aspects. The guarantee of a robust and affected person-centered option payment design pathway for doctors underneath MACRA has yet to be realized, leaving the vast majority of procedures trapped in the MIPS portion of the MACRA software, with legacy and siloed expense and excellent measurement applications that impose steep administrative burdens even though lacking clinical relevance. We are unable to reach the guarantee of higher-top quality, coordinated treatment that will help patients accomplish best overall health if the limitations to good results in the MACRA plan are not examined and tackled. The state of the plan is more and more dysfunctional and, ultimately, it will be people who undergo.

In the interim, the AMA strongly urges Congress not to divert progressively scarce overall health care dollars for non-overall health treatment needs, specially when there are so several uncertainties and latest policies are already undermining the Medicare health practitioner payment program.


James L. Madara, MD