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Medical groups want Congressional action to reform Medicare reimbursement


Family physicians lead charge to get issue on federal agenda early in 2023.

Medical groups want Congressional action to reform Medicare reimbursement

This graph prepared by the American Academy of Family Physicians shows Medicare reimbursement cumulative changes from 2001 to 2021 for hospitals and physicians. AAFP included it in a Jan. 23, 2023, letter to Congress urging national lawmakers to make Medicare payment reform a priority this year.

Medicare payment reform needs to be on the agenda early for the U.S. House of Representatives and Senate, according to physicians who say declining reimbursement will hurt health care for seniors.

Medical groups want Congressional action to reform Medicare reimbursement

R. Shawn Martin, MHCDS

Medical groups representing more than 1 million physicians and other clinicians sent a welcome letter to members of the 118th Congress convening this month in Washington. It included a request: more money for doctors through comprehensive upgrades to Medicare reimbursement.

It will be a cornerstone of 2023 advocacy by the American Academy of Family Physicians (AAFP), Executive Vice President and CEO R. Shawn Martin, MHCDS, said in a news release.

“While we have made progress, reforms are urgently needed to support family physicians, their patients, and communities, and facilitate large-scale transition to value-based care,” Martin said.

Since 2001, reimbursement rates for physicians have inched up at a rate far below those for hospitals and skilled nursing facilities. When adjusted for inflation, the reimbursement rates have dropped 22% from 2001 to 2021, based on an analysis of Medicare data by the American Medical Association.

Recent congressional action mitigated some cuts in the Medicare Physician Fee Schedule (MPFS), but that’s not a long-term solution as payments decline, the medical groups said. There is no inflationary update built into the MPFS, but administrative burdens and the costs of doing business continue increasing, they said.

“Medicare physician payment hasn’t kept pace with rising practice expenses. On top of that, physicians still face an unacceptable 2% reduction in the Medicare conversion factor this year,” AAFP President Tochi Iroku-Malize, MD, MPH, FAAFP, said in the news release. "Congress will find they have an ally in family physicians when enacting meaningful legislation that will ensure patients can get the care they need and deserve."

Medical groups want Congressional action to reform Medicare reimbursement

Tochi Iroku-Malize, MD, MPH, FAAFP

Reforming the Medicare payment system is a crucial to maintain the clinician workforce necessary to serve America’s seniors, said the Jan. 23 letter to Congress. AAFP was one of 104 medical groups to sign the missive to Congress.

“Unfortunately, we face an increasingly challenging environment providing Medicare beneficiaries with access to timely and quality care, which is particularly important for underserved and rural areas,” the medical groups’ letter said. “The medical community continues to contend with the residual impacts of the COVID-19 pandemic, a new triple-demic in many regions of the country, record levels of burnout, workforce shortages, and ongoing reductions to Medicare Part B payment and private payer reimbursement.”

Hearings should start as soon as possible with the goal of “comprehensive, transformative reforms to the Medicare payment system over the next several years.”

“Such reform is imperative to sustaining medical practices and ensuring a robust workforce to care for the growing number of America’s seniors,” the letter said.

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