Jobs, health care access on the line if Medicare makes another cut to physician reimbursement: survey

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Jobs will be affected and patient access to health care will decrease if doctors see another cut to reimbursement in the Medicare Physician Fee Schedule (MPFS), according to a new survey.

The American Medical Group Association (AMGA) polled members about effects of this year’s decline in Medicare pay, and the potential for what’s to come in 2025. The results are not good: Almost 70% said they will have hiring freezes or delays, and they will have to eliminate services next year. That’s on top of 54% reporting hiring freezes or delays this year, and 42% eliminating services due to cuts that happened in 2024.

This week, a bipartisan group of 233 representatives signed a letter calling for House of Representative leadership to bring physician reimbursement to the floor for action. AMGA credited the work of Rep. Mariannette Miller-Meeks, MD (R-Iowa) and other representatives, including other physicians in Congress, for that joint letter.

Jamie Miller, AMGA senior director of government relations, and Danielle DuBord, a consultant with AMGA Consulting, spoke with Medical Economics about the poll results and what the potential 2.8% cut could mean for medical practices. This transcript has been edited for length and clarity.

Medical Economics: How would you summarize the results?

Danielle DuBord: We had responses from almost 80 medical groups representing over 64,000 providers across the country, all regions, all group sizes and organizations really identified different areas within in the system, both what they have done in 2024 as a result from the cuts that took effect in 2024, as well as additional steps that they would take in 2025 if those cuts continue. What we've then also done is looked at the survey from last year, where we also asked the question the same way, what are you doing this year and what could you do next year, to really gauge how groups are moving the needle in regards to the downstream effects of these Medicare cuts. And what we're seeing is really, it is overall affecting patient access. We're seeing hiring freezes, delays in population health, delays in delivery system improvements and care modeling. And really what that access is affecting, it's not just affecting your ability to see a doctor or a provider, but it's also affecting your ability to utilize different population health Initiatives, with care management, community outreach and that sort of thing.

Medical Economics: What was the most surprising thing about the findings?

Jamie Miller: I think one of the most surprising things was, this is not going away. This is an inflection point for our members. They're not embellishing. This is just not sustainable. You know, this is the fourth year, coming on the fifth year, of these cuts. If something doesn't happen, we're really worried about, like Danielle mentioned, our patients’ access to care. They're already eliminating services, not taking new Medicare beneficiaries, laying off clinical and nonclinical, hiring freezes. We have the gray wave coming with new retirees, and also physician workforce issues with people retiring from the physician workforce and just the in-general workforce. And it's just very concerning that if you keep doing these cuts year after year after year, this can dramatically impact our members’ ability to provide care and the patients’ access to that care. And that's when we talk to Congress, they understand, we help them understand that this is about access to care. This isn't about physician compensation. This is about care management. This is about having the right people at the right time taking care of this population.

Danielle DuBord: When we're talking about that gray wave, it's hitting health care on two fronts. You have an aging workforce across all levels of health care. From your physicians, your front office, back office, everyone there, they're all aging and retiring out of the system. We understand from the survey itself that there's a hiring freeze or a delay in hiring, so these positions are not being filled. And at the same time, you have an increased demand for services from health care, your patient, access to your providers and your health care initiatives. And so it's really kind of a double-edged sword when you're thinking of your population that is seeking health care.

Jamie Miller: And I would just add, if our members want to plan for the future, they need a stable reimbursement system. We hear that from everybody. It's kind of like with tax codes and trying to plan any type of construction or capital. If you're trying to invest in the future, and you're like, well, next year, I'm going to get a 4% cut, so it's really hard to plan for the future.

Medical Economics: Just this week, there was an announcement about a bipartisan call to action in the House of Representatives to reform Medicare reimbursement for physicians. Does AMGA support that? And what other reforms would you like to see?

Jamie Miller: First off, yes, we support it. We endorsed the letter. It began with Representative Miller-Meeks, who's a physician out of Iowa. Got 232, and so in the house, you need 218 people to pass a bill. This is a very symbolic gesture that a majority of the House wants to fix this. So yes, we are very supportive. But that only gets us to the end of the year. We're working with the House and the Senate on long-term Medicare physician payment reform. Doing any kind of major Medicare reform takes years. In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act, MACRA. That took two years. So we're in the early stages working with the House Ways and Means Committee, the House Energy and Commerce Committee, the Senate Finance Committee, and then the House and Senate leaders, and they're very aware of AMGA. We're suggesting tenets to bring us into the next evolution of health care, working on patient engagement, end of life care, rural and underserved care, legislative, regulatory barriers. We're also working on Medicare sustainability. So there's a lot of things. We're not just talking about reimbursement. We're talking about giving the physician community leadership an opportunity to lead and make and give their patients better access to care, because it's more than just money. It's about having the right to take care of your patients.

Medical Economics: What did I not ask about? Or what would you like our readers to know about the results or about the situation?

Jamie Miller: I would just say that we can't move to the future. If we can't stay in the present. I mean, we can't even if we can't sustain our labor force, our population health initiatives, andhave that year to year, then we're not going to be able to move into the future. We are hopeful about the House members signing that letter, and we will definitely be lobbying them actively. And our members have been very adamant about prioritizing this. But like I said, it's not just about Medicare reimbursement. It's about symbolizing that we are a partner with the government to take care of these patients instead of someone who just gets various cuts for unknown reasons. So that's our intention, at least.

Danille DuBord: And Jamie, I liked how you said, we can't sustain what we're doing now, if there's continued cuts. And really looking forward, we're seeing that in the survey results, that the groups are doing what they can to mitigate these cuts right now. They've had these cuts year over year for multiple years, and they don't know what they can sustain going forward with them. And that affects both internally within health care and then patient access as well.