Doctors are in the waiting room — and they hate it

Politico Pro

February 3, 2024 10:47 am

It’s an annual rite of fall at the Capitol: Physicians and their allies descend to protest Medicare payment cuts, warning it will imperil their practices and their patients.

Congress typically obliges, reducing or eliminating the cuts before they take effect. But nearly a month into 2024 lawmakers are late — and doctors are fuming.“Medical practices are feeling like it is death by a thousand cuts,” said Anders Gilberg, the senior vice president of government affairs for the Medical Group Management Association.

Congress’ failure to mitigate the 3.4 percent Medicare rate cut that took effect this month could prompt doctors to reconsider whom they serve, according to Rep. Greg Murphy (R-N.C.), a surgeon and one of the leaders of the GOP Doctors Caucus.

“You’re really destroying access for a growing number of Medicare patients,” he said.

The Biden administration finalized the reduced rates last fall relying on a mandated payment formula last revised in 2015.

The announcement triggered a fervent but unsuccessful lobbying effort from doctor groups who were counting on lawmakers to stave off the cuts as they had often done before.

But 2023 wasn’t like earlier years. There was no big funding package in December and the prolonged spending fight means any fix for physicians likely won’t come until March, the next deadline to keep the government open.

“That’s when, process-wise, I think that could happen,” said Sen. Bill Cassidy (R-La.), also a physician and the top Republican on the Senate Health, Education, Labor and Pensions Committee. The panel is working with the Finance Committee on a health care bill that could be a vehicle>

Murphy is contemplating a way to get doctors more money faster. He told POLITICO that he hoped his proposal, which would stop the cut altogether, could pass the House under a suspension of the rules, in which debate and amendments are limited and bills can pass with a two-thirds majority.

But even as he hopes for a faster fix, Murphy agreed with the staffers and lobbyists who spoke to POLITICO about the payment cut: He believes the reduction is most likely to remain through early March, when the current continuing resolution funding the government expires.

Lobbyists for doctors’ groups have tried to attach a fix to earlier continuing resolutions, including one in November.

There was hope that it would be included in a Jan. 18 spending package, with leadership in both parties interested, according to Republican and Democratic staffers familiar with the discussions and granted anonymity to discuss private negotiations — but it fell through.

Republicans were willing to include doctor pay, but not other priorities Democrats insisted on: community health centers, Medicaid and mental health funding.

Even if Congress does intervene, it’s uncertain how much it will reduce the cuts — or if it will eliminate them. Some lobbyists representing doctors went into negotiations last year believing a rate cut of some amount is inevitable.

The Senate Finance Committee has approved legislation to reduce the cut from 3.4 percent to 2.15 percent as part of a larger bill that it unanimously cleared last November.

Finance Chair Ron Wyden (D-Ore.) was optimistic about the package’s prospects after that committee vote.

“I think that was an indication of the support out there for tackling these health care costs,” he said.

The clock is ticking. In the past, some practices have held back claims in the hopes of filing after the pay cuts are reduced — but many can’t wait until March, according to several doctor groups.

Murphy hopes that Congress will offer back pay to doctors with any bill it passes.

While Congress traditionally acts before a Medicare rate change takes effect, it has missed deadlines before.

From 2003 through April 2014, Congress passed 17 temporary patches to prevent steep Medicare cuts from taking effect, according to a report from the Congressional Research Service. The patches ranged in duration from several years to less than a month, and on three separate instances lawmakers let the cuts take effect for a short period of time.

Congress fixed part of the payment issue in the Medicare Access and CHIP Reauthorization Act of 2015. But now lawmakers say those reforms need revisiting.

CMS must abide by budget neutrality rules when calculating Medicare payments to doctors, ensuring that any spending hikes are offset if they reach a certain level.

GOP Doctors Caucus members introduced legislation last year to reform the process for paying physicians. The bill would raise the threshold for triggering the budget neutrality rules.

But it remains unclear whether such a big change can pass in an election year.

“There is always the lame duck,” said Susan Dentzer, president and CEO of America’s Physician Groups. “Sometimes big things do happen in the lame duck session but often those are things pretty well baked before the election.”