Medicare pay cuts ‘too deep and relentless’: AMA chief


With the impending 3.37% reduction in Medicare physician salaries in 2024, alarming rates of physician burnout, and unsafe scope-of-practice expansions, medicine is not just at a crossroads. It is a crisis, and doctors must push for a more sustainable system that preserves patients’ access to high-quality medical care.

“It has to be us — because we experience the reality of a broken health care system every day,” said AMA President Jesse M. Ehrenfeld, MD, MPH, during his remarks at the opening session of the AMA’s 2023 Interim Meeting. National Harbor, Maryland, across the Potomac River from Capitol Hill. (Read Dr. Ehrenfeld’s letter.)

“Our voices, our stories and our experiences are powerful voices — and we must amplify them to shine a light on what’s really happening in our health care system,” said Dr. Ehrenfeld, who shared how his parents were affected by Medicare’s broken physician payment system.

His parents, both in their 70s and suffering from “a number of age-related ailments,” were struggling to get primary care because Medicare’s woefully inadequate payments, which are not tied to inflation, are not enough to sustain a growing number of practices.

“Too many seniors, like my father, have gotten the same message,” Dr. Ehrenfeld said of notices that practices are closing or no longer providing services to Medicare patients. “This typically leads to a frustrating and frantic search for an alternative, often causing harm, with delays occurring, some things being missed during the transition, and patients often ending up having to travel further to receive necessary services.”

Dr. Ehrenfeld said the looming cuts in Medicare payments are “very profound, relentless, and affecting the lives of many doctors and patients alike.” “We must keep up the pressure. We will.”

Leading the charge to reform Medicare pay is the first pillar of the AMA’s recovery plan for America’s physicians.

The AMA has challenged Congress to act on systemic reforms and make Medicare work better for you and your patients. Our work will continue, fighting tirelessly against future cuts – and against all barriers to patient care.

At Dr. Ehrenfeld’s request, delegates in the hall took out their smartphones to scan the QR code that was displayed on the video screens. This took them to the Fix Medicare Now website where they clicked the “Take Action Now” button, allowing them to email directly to their representative in Congress and demand support for the Medicare Enhancement Act for Patients and Providers.

Dr. Ehrenfeld noted that the bipartisan House bill is a bill that “will do.” Do what the AMA has long called for — link the Medicare physician payment schedule to the Medicare economic index.

“We will send a message to Congress, tonight, right now, and tell them: Enough is enough,” he said.

Adjusted for inflation, Medicare physician wages have fallen 26% since 2001, while payments to hospitals and nursing facilities have kept pace with inflation.

“I don’t know of many companies in any industry that can withstand a 26% decline in revenue and continue to survive — let alone an industry like ours that is so essential to our nation’s health, vitality and economic well-being,” he said. Dr. Ehrenfeld, senior associate dean and tenured professor of anesthesiology and director of the Wisconsin Health Advancement Endowment at the Medical College of Wisconsin.

Dr. Ehrenfeld cited recent successes in other aspects of the AMA’s recovery plan for American physicians, such as addressing prior authorization and combating scope creep. These positive steps include:

  • A new regulation from the Centers for Medicare and Medicaid Services limits the amount of prior authorization in Medicare Advantage plans and ensures continuity of care while improving process transparency.
  • 72 health systems, hospitals and medical groups were honored this year through the Joy in Medicine™ health system recognition program, which highlights organizations that have taken key steps to address the systemic causes of physician burnout.
  • AMA advocacy, in coordination with state medical associations and national specialty societies, helped defeat more than 85 inappropriate scope expansion bills in state legislatures this year.

On the practice front, Dr. Ehrenfeld recalled his testimony before the House Veterans Affairs Committee regarding the VA’s Federal Excellence Project, which threatens to override state scope of practice laws and reduce the quality of care veterans receive.

“At that session, I sat next to an ophthalmologist who referred to himself as a doctor,” Dr. Ehrenfeld said, to sounds of disbelief in the crowd. “It was another gruesome reminder of why we need to continue to address these expansions. And why we need to raise the bar for physicians as leaders of health care teams.”

Despite the headwinds on Capitol Hill and in the state capital and the major challenges facing the US health system, Dr. Ehrenfeld said doctors cannot give up hope.

“On all of these issues, I continue to be guided by a sense of optimism and purpose because I see the real progress we have made,” Dr. Ehrenfeld said.

“I see the ability of everyone in this room to force change that makes a real difference in the lives of patients and doctors,” he added. “It has to be us, because — despite ongoing efforts to undermine trust in science and medical institutions — people still trust and believe their doctors.”

After concluding his remarks with a standing ovation, Dr. Ehrenfeld led delegates in the hall in a chant of “Fix Medicare Now” while holding aloft banners bearing that slogan and “Ensuring Access to Care,” among other reasons behind Medicare payment reform. necessary.

Read about other highlights from the 2023 AMA Interim Meeting.

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