Medical groups push back against planned Medicare payment cuts

Medical groups are urging President Biden’s administration to revise planned Medicare cuts which they said could harm practices.

The Medical Group Management Association sent a letter Tuesday outlining concerns to Chiquita Brooks-Lasure, administrator of the Centers for Medicare & Medicaid Services.

The MGMA is especially concerned about a projected reduction in the complex conversion factor determining payments. The conversion factor is estimated to drop 4.4% in 2023, compared to 2022.

The CMS has said essentially that its hands are tied due to federal law requiring payment rates for services don’t lead to higher Medicare spending.

Nonetheless, medical groups said the cuts “are simply unsustainable.”

The MGMA polled its members Aug. 30 and found 90% of medical practices said the projected Medicare payment cuts, if they occur, will reduce access to healthcare.

Anders Gilberg, the MGMA’s senior vice president of government affairs, noted in the letter that medical groups don’t need additional burdens in the challenges of the COVID-19 pandemic. Medical groups and health systems have been struggling financially as they face higher costs and a labor shortage. Health systems around the country are reporting substantial losses.

“Staffing shortages jeopardize patient outcomes and increase costs for practices and waste for the healthcare system,” Gilberg wrote.

“Looking ahead to Medicare payment policies in CY 2023, each proposed policy must be considered in the context of the current state of the healthcare system; one in which practices do not have excess time, staff, or resources to devote to administratively burdensome tasks that neither add value nor improve the quality of care provided to patients.”

More than half (58%) of all medical groups surveyed in the Aug. 30 poll said they would consider reducing the number of clinical staff if the cuts go occur, and 58% said they would consider limiting the number of new Medicare patients they serve. Nearly 3 out of 10 (29%) groups said they would consider closing satellite locations.

If the cuts go forward, medical groups project that patients would likely endure longer waits before seeing a doctor, with some looking at waits lasting for up to 6 months, the MGMA says.

The MGMA is also asking the Biden administration to extend telehealth services.

Under the federal spending package approved in March, President Biden and Congress agreed to continue telehealth waivers five months beyond the end of the COVID-19 public health emergency. The MGMA is asking CMS to cover and pay for audio-only services permanently.

The MGMA has asked the Biden administration to continue the public health emergency beyond mid-October, when it is slated to expire. Analysts expect the emergency will go beyond that point, since federal officials have said they would offer 60 days notice before ending the emergency. The MGMA has asked the government to provide at least 90 days notice so providers can have more time to prepare.

Lawmakers are also pushing measures to continue telehealth waivers through the end of 2024. The House overwhelmingly approved the legislation, but it still must pass the Senate. Advocates say senators in both parties back the bill but that it’s not a lock the Senate will pass it before the congressional term expires at the end of the year.

The MGMA and other health advocates are worried about the prospect of automatic spending cuts in Medicare slated for 2023, if Congress doesn’t intervene. Medicare could see cuts of $36 billion under statutory requirements that call for the agency to offset higher costs by reducing spending elsewhere (often called the “pay-as-you-go” provision, or PAYGO).

The MGMA represents more than 15,000 medical groups with more than 350,000 doctors.