‘It is just a real gut punch’ – Physician in Congress discusses proposed reduction in Medicare Physician Fee Schedule

The sponsor of legislation to stop a cut in Medicare reimbursement to physicians said he is optimistic Congress can address the issue as 2024 draws to a close.

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Rep. Greg Murphy, MD (R-North Carolina), introduced the Medicare Patient Access and Practice Stabilization Act to stop a proposed 2.8% cut to physician pay in the 2025 Medicare Physician Fee Schedule.

He spoke to Medical Economics about MPFS, the legislation and the limited time Congress has left to approve it in 2024. This transcript has been edited for length and clarity.

Medical Economics: The 2025 Medicare Physician Fee Schedule has a proposed 2.8% cut for physician reimbursement. What does that mean for doctors?

Rep. Greg Murphy, MD (R-North Carolina)

Rep. Greg Murphy, MD: It means a lot of things because it is salt in a wound that has had its scab, as it were, pulled off year after year after year. Last year, we were fighting a 4.8% decrease and I led that effort to try to stop that. I was not able to be successful in stopping the whole thing, but got it down, at least cut in half. This year now, with another 2.8% decrease in the face of, what, 14, 16, 18% medical inflation, it is just a real gut punch to those of us – and I count myself as one, as I'm practicing – who are delivering the care to our patients. We cannot survive on the fumes that the federal government is paying us through Medicare and the cuts need to stop. If Hardee's or McDonald's, inflation goes up, they raise their prices. We don't get a chance to do that because they're negotiated rates with either Medicare or with insurance companies. So, all of it, all of it, has to come from our bottom line.

Medical Economics: There is legislation pending now in the house. Can you discuss the Medicare Patient Access and Practice Stabilization Act?

Rep. Greg Murphy, MD: We submitted this last week, and it is to get rid of the 2.8% cut and in fact give a 1.8% raise because of medical inflation, which is, as I just pointed out, a fraction of medical inflation. But that said, this is to stop the bleeding and add a little bit to let us get back on track. I think there will be good bipartisan support. I had assurances from the speaker before October recessed that this issue will be dealt with. And so I'm very optimistic that the bleeding will stop for this year. What we really need to do is stop it completely.

Medical Economics: Rep. Mariannette Miller-Meeks, who is also a physician, led an effort to publicly announce bipartisan support for stopping reimbursement cuts to physicians. In an era with a lot of political divisiveness, what does it mean to have that strong bipartisan support for the bill?

Rep. Greg Murphy, MD: I think bipartisan support is critical. And I was a co-lead with Dr. Miller-Meeks on that letter. I always kind of feel difficult addressing or, I hate to say, calling out leadership, to say, hey, deal with it. But we're really at a crossroads as far as physicians’ ability to continue, especially in private practice, with these continued cuts. That said, you know, we got it over to the Senate last time, and sadly enough, physician fees and payment for physicians has turned into a little bit more of a partisan issue than it ever has before, because we have some senators on the other side of the aisle than I am, that have some certain wish lists that they want to try to trade and barter for. This doesn't need to be any trade and bartering. It needs to be a single, solitary issue. It needs to be one that is bipartisan support, which is what we have. And it needs to be one and done and get this finished.

Medical Economics: Will this bill require committee review, and either way, how many days are left for the House to meet, either in committee or to vote on the legislation?

Rep. Greg Murphy, MD: We've only got a couple weeks in November and a couple weeks in December, so the time is short. Again, I've been assured by the speaker that this issue will be dealt with sometimes through the rules, were able to release the jurisdiction of a certain committee and bring it directly to or attach it to another bill. I feel very confident that we're going to be able to get the issues settled before the end of the year.

Medical Economics: The population of America is getting older, that's going to lead to both more people who are qualifying for Medicare as well as more use. What are your thoughts on long-term prospects for Medicare reimbursement, especially as the population ages?

Rep. Greg Murphy, MD: Medicare, you know, in 1965 it was put out as this great cure all for folks who, once they achieve 65 years old, would have some type of health care insurance. It was great in concept. The problem is, in 1965 they didn't anticipate life expectancy would be, you know, in 2024, 2025, would be up to 10 years longer. And so that extra, that delta, that 10 years, costs a lot more money because we have newer, more expensive medications, we have more expensive treatments, we have a lot of things, and actually more utilization during that time. The other thing is, back to 1965, there were 4.6 individuals paying in for each recipient of Medicare. That number because, population is shifting where we add 10,000 a day to the Medicare rolls, that number has dropped from 4.6 to about 2.6, so there are fewer people paying into the system. And you know, truth be told, for each recipient, for every dollar that they paid into the Medicare system, they're usually getting about four out. And so the numbers are not working right now. There needs to be major reform to the Medicare system in so many different avenues. But at the same time, we have such a huge physician shortage, especially surgeons like myself, and to keep them practicing, we have to pay them what it costs to run a practice. And so it's a difficult situation, truth be told, the one I'm looking forward to really, really trying to solve.