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CMS must level playing field for independent physicians

Article

Independents have more credibility with patients, but less reimbursement than hospitals, despite the same inflationary challenges.

Editor’s note: The following guest commentary was written by Evan R. Goldfischer, MD, in response to the Medical Economics article Physician payment outlook, published online Jan. 31, 2023.

CMS must level playing field for independent physicians

Evan R. Goldfischer, MD
LUGPA

As president of LUGPA, the largest U.S. nonprofit urology trade association, I share the disappointment of the American Medical Association (AMA) and the Medical Group Management Association (MGMA) that the physician payment cuts were finalized by the U.S. Centers for Medicare & Medicaid Services (CMS). These cuts are particularly destabilizing for independent physician practices, meaning those not owned by large hospital systems. This reality highlights a need to educate policymakers and patients about why these payment cuts will only exacerbate the rising challenges for Americans to access individualized care throughout the U.S.

Providers who are paid on the Medicare Physician Fee Schedule are the only sector within Medicare that lack an annual payment update. As the Medical Economics article notes, the physician portion of Medicare costs is dwarfed by payments to hospitals. Moreover, hospital systems are often compensated substantially more than physicians by Medicare for identical services. Congress must focus on leveling the playing field between hospital and independent physician reimbursement to ensure that independent physician practices can compete with hospital systems and continue to provide options for high-quality care in communities across the U.S. After all, physician practices confront similar inflationary pressures to hire and retain nurses, back-office staff, and medical supplies.

LUGPA has been in direct dialogue with key legislators in Congress on the importance of addressing site-of-service payment disparities, encouraging greater competition and deterring further hospital acquisitions of physician practices. Many of these issues that LUGPA has been advocating for to help independent physicians were included in the solutions released recently by The Healthy Future Task Force. LUGPA is continuing working with committees of jurisdiction to flesh out solutions and help build bipartisan support to advance these priorities. In addition, policymakers can improve programs that reward high-quality, cost-effective care. As such, LUGPA is leading the effort to develop urology-specific electronic Clinical Quality Measures (eCQMs) for the Merit-based Incentive Payment System (MIPS), which can be especially useful for independent physicians.

According to a survey from LUGPA, 65% of Americans trust independent physicians to give the best recommendation, and Americans are more likely to associate independent physicians with individualized and patient-focused care compared to physicians employed by hospitals. Independent practices also typically have a lower average cost per patient. As suggested by research time and time again, including by a recent JAMA study, prices paid to health systems are significantly higher than prices paid to nonsystem physicians.

These independent practices must be allowed to fairly compete within the U.S. health care system to allow patients choices for where they seek care, including for specialty care. For seniors and other Medicare beneficiaries, these cuts will diminish access to high-quality care in their communities at a time when resources are already limited. It is my ardent hope that Congress seeks out innovative ways to reform physician payment, so all physicians can provide their patients and communities with timely access to high-quality and cost-effective care.

Evan R. Goldfischer, MD, is president of LUGPA, the only nonprofit urology trade association in the U.S. Founded in 2008, the Association is open to groups of any size engaged in the independent practice of urology. LUGPA is celebrating its 15th year with the mission: to preserve and advance the independent practice of urology while demonstrating quality and value to patients, vendors, third-party payers, legislators, and regulatory agencies.

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