Medicare physician reimbursement: ‘I think it’s appalling that Congress hasn’t fixed this’

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The 2024 Medicare Physician Fee Schedule needs reforming to increase the amounts paid to doctors, according to physicians and their supporters in Congress.

Rep. Larry Bucshon, MD (R-Indiana), is both. He spent years as a practicing physician and cardiothoracic surgeon before being elected to Congress in 2010. As vice chair of the Health Subcommittee of the House Committee on Energy & Commerce, he has reviewed numerous pending bills that would affect health care and medicine around the nation.

On Feb. 16, Bucshon spoke to Medical Economics about the latest efforts in Washington to restore the 3.4% cut in physician reimbursement that went into effect at the start of 2024.

Rep. Larry Bucshon, MD (R-Indiana)

This transcript has been edited for length and clarity.

Medical Economics: Since last year, physicians have been asking lawmakers to reverse a 3.4% cut in reimbursement to doctors in the 2024 Medicare Physician Fee Schedule. We're into 2024. Is there still a way that Congress could take action on that cut?

Rep. Larry Bucshon, MD: I think so. You know, there's bipartisan support for getting rid of most of the cut. I think I'm optimistic that that will happen. It almost did in the last continuing resolution that we just passed, but there was on the Senate side, a dispute about some other health-related programs, community health centers and that level of funding, and so they couldn't come to an agreement to find a solution to the to the cut, but I'm pretty optimistic that Congress will mitigate if not all most of the 3.4 percent cut. I mean, let me just say this: This should not be partisan, not a partisan issue, and I don't think it is. America's physicians, you know, particularly during COVID worked hard. Some lost their lives taking care of a COVID patients, and day to day, we're all relying on them. It just makes no sense when you're offering up billions and billions of dollars for all kinds of other things that we can't find about $1.8 billion, roughly, to mitigate this 3.4 percent cut. So, I'm optimistic and we'll see where it goes.

Medical Economics: Would that be standalone legislation, or would it be part of a continuing resolution like you had mentioned or a different spending bill?

Rep. Larry Bucshon, MD: I'm hopeful it's going to be part of an appropriations bill and not another continuing resolution, that it will get rolled into one of the appropriations bills, probably Labor, HHS (U.S. Departments of Labor and of Health and Human Services) or other legislation like that. But I don't know, I don't control that part of it. At a minimum, if there is another continuing resolution, I would hope there would be mitigation of this cut in there, but ideally, get the appropriations bills across the finish line, and include a fix to this. Again, $1.8 billion dollars for Washington, D.C., is literally a rounding error. I mean, it's just not that much money. And I think, honestly, and I've said this publicly, I think it's appalling that Congress hasn't fixed this for America’s physicians, and we need to. This type of physician reimbursement cuts over the years have led many medical practices to sell to larger organizations, whether it's a large national practice or whether it's a hospital system, and it's led to consolidation and higher health care costs. So, we need to pay our physicians for their value. And I think they're very valuable, and we need to reward that with proper payment level from the government.

Medical Economics: Medical groups have called for reforms to Medicare's physician payments. Do you support reform and how exactly would you like to see that change?

Rep. Larry Bucshon, MD: Absolutely, I support reform and there's a number of things that we can do. First, there's budget neutrality at CMS (The U.S. Centers for Medicare & Medicaid Services). What that means is, that their pie stays the same and you have to try to divide that up amongst the medical community. So, if you if you give more reimbursement to surgeons, you're going to have to cut primary care and vice versa. There is legislation out there, Dr. Michael Burgess (R-Texas) and others have, (HR 6371, the “Provider Reimbursement Stability Act of 2023,”) that would expand the size of that of the budget neutrality pie, so that we can make sure that everybody gets a pay raise. I'm for rising all the boats up, not just certain sectors of our health care system.

That's one thing, budget neutrality. The other is updates annually based on inflation. I have legislation, HR 2474 (the “Strengthening Medicare for Patients and Providers Act”) that does actually that. If you look at what happens every year with reimbursement through CMS, hospital services, inpatient, outpatient, get an annual inflationary update, and based on most of the time to CPI (the U.S. Consumer Price Index), and my bill would increase physician reimbursement based on the Medicare Economic Index, not the Consumer Price Index. It's slightly lower growth every year for that, but what that means is that if practice costs are going up from inflation, then reimbursement gets adjusted for those costs. And that's the Medicare Economic Index. That's another avenue that we need to address. So, both of those ways are the ways to address annual reimbursement challenges that we have over at CMS.