Leaders of the U.S. Senate Committee on Finance continue advocating for reform in how Medicare pays radiologists and other physicians amid years of stagnation.
The legislative body held a hearing on this topic April 11, titled “Bolstering Chronic Care through Medicare Physician Payment.” It featured testimony from medical association leaders representing surgeons and family physicians, among others.
Committee Chairman Sen. Ron Wyden, D-Ore., emphasized that Medicare is “no longer only an acute care program.” Rather, program spending is “dominated” by chronic conditions “with a crazy quilt of appointments, prescriptions and care plans that lead to confusion and worse healthcare.”
“I know members of the committee are interested in reforms to the way physicians and nonphysician practitioners are paid,” Wyden said in prepared remarks. “In my view, any update to the way physicians are paid by traditional Medicare must provide a lifeline to the tens of millions of seniors who live with chronic conditions and who are struggling to coordinate their healthcare in a fragmented health system that’s not putting their health first.”
Both Wyden and Ranking Member Mike Crapo, R-Idaho, shared a commonly cited statistic: In inflation adjusted terms, Medicare Physician Fee Schedule payments have declined 25% over the past 20 years. During the same time, radiologists and other doctors have faced “skyrocketing costs for overhead, equipment, supplies and staffing needs,” Crapo noted. More than 60 million Americans now rely on the payment program, with the pool expected to grow by 20% over the next decade.
“From 2014 to 2023, for instance, even before adjusting for inflation, the fees for chemotherapy administration and IV infusions declined. Under these conditions, it should come as no surprise that many physicians have opted to sell their practices, join health systems or limit new Medicare patients,” Crapo said in his prepared remarks.
Idaho’s senior U.S. senator also highlighted Congress’ previous action nine years ago to repeal the “draconian” Sustainable Growth Rate system, which had threatened “decades of dramatic cuts.” Enacting the Medicare Access and CHIP Reauthorization Act was supposed to stabilize the fee schedule and move physicians away from fee-for-service medicine.
“In practice, these reforms have largely failed,” Crapo said. “The Merit-based Incentive Payment System aimed to establish an accessible on-ramp to participation in quality-driven alternative payment models, or APMs. Instead, this system has buried clinicians in dozens of hours of paperwork each year, all in exchange for potential, marginal payment bumps, based on ambiguous metrics that lack meaningful value for patients.”
Wyden said he hopes to get working on next steps soon after the hearing. You can watch a recording and read full testimony from the two senators, the American College of Surgeons and others here.
The American College of Radiology published a news update about the hearing April 11, noting that the trade group “will continue its work with Congress on substantive Medicare payment reform to ensure beneficiaries continue to have access to high quality patient care.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.