Boosting Medicare payments to doctors | Bills and Laws

The skinny

Advocates for doctors are pushing legislation to boost Medicare payments to doctors.

A bipartisan group of lawmakers are pushing legislation to increase Medicare payments for doctors. From left: U.S. Reps. Raul Ruiz, D-California; Larry Bucshon, R-Indiana, Ami Bera, D-California; and Mariannette Miller-Meeks, R-Iowa.

Sponsors

A bipartisan group of lawmakers are prime sponsors, and they’re all doctors: U.S. Reps. Raul Ruiz, D-California; Larry Bucshon, R-Indiana, Ami Bera, D-California; and Mariannette Miller-Meeks, R-Iowa. The measure has 149 co-sponsors: 110 Democrats and 39 Republicans.

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Summary

The legislation would adjust payments under the Medicare physician fee schedule. Specifically, the bill would tie Medicare physician payments to annual increases in the Medicare Economic Index, reflecting the costs of inflation for providers. The legislation (H.R. 2474) is dubbed the Strengthening Medicare for Patients and Providers Act.

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Analysis

Ruiz and fellow lawmakers introduced the legislation in April 2023, but the bill has received fresh attention in recent weeks.

Healthcare groups have urged Congress to move on the legislation after the Centers for Medicare & Medicaid Services unveiled its planned Medicare payments for physicians in doctors in 2025. For 2025, the CMS has proposed a 2.8% cut in the conversion factor, the formula used to set payments for physicians.

Physicians are fuming over next year’s Medicare payments. Bruce Scott, MD, president of the American Medical Association, noted that if the cuts are enacted, it would mark the fifth consecutive year of reductions in payments to doctors.

Adding to their anger, Medicare is also projecting a 3.6% increase in the Medicare Economic Index. With projections of higher costs and lower payments, again, advocates for doctors blasted CMS and also urged Congress to take action.

In an op-ed published in The Hill last fall, the four prime sponsors of the bill pointed out that adjusted for inflation, Medicare payments to physicians have plunged 26% from 2001 to 2023.

The lawmakers wrote that the bill “would help ensure fairness, provide financial stability for physicians, and protect vital access to care for millions of patients nationwide.”

Supporters

The AMA has strongly endorsed the bill and is urging Congress to approve the bill.

“The consecutive years of Medicare cuts demand a comprehensive legislative solution,” Scott said in a statement after CMS released its payment proposals earlier this month. “Previous quick fixes have been insufficient—this situation requires a bold, substantial approach.”

The American Academy of Family Physicians has also endorsed the legislation. Steven P. Furr, MD, the AAFP’s president, called on Congress to help physicians after the CMS released its plan to cut payments again next year. Furr said in a news release that the proposed reduction “once again highlights the urgent need for congressional action to ensure that physician payments keep up with the costs of running a practice.”

Tanya W. Spirtos, president of the California Medical Association, also endorsed the measure this spring. By passing the measure, she said in May, “Congress can finally address the broken Medicare payment structure and ensure patients get the access to care they need and deserve.”

The Medicare Advisory Payment Commission, which counsels Congress on Medicare policy, has suggested tying Medicare’s physician payments to inflation.