If you’ve been forced to wait for medical care recently, you’re not alone. In the past year, a third of patients have been unable to see a doctor due to availability issues. Even among those who were able to get an appointment, one in five had to wait one to three months to be seen.
There is already a serious shortage of physicians. The Association of American Medical Colleges projects a national shortfall of up to 86,000 physicians over the next decade. With 35% of doctors saying they plan to leave practice in the next five years and not enough physicians entering the profession to meet demand, the problem will only get worse.
To help ensure access to care, Congress must address the lingering issues that were left on the table at the end of last year—including reversing a 2.8% cut to physician practices under the Medicare Physician Fee Schedule (MPFS) and putting guardrails around prior authorization. Unfortunately, the spending package Congress unveiled over the weekend continues to leave these critical issues by the wayside. This reckless decision positions doctors for a fifth consecutive year of payment cuts and continued prior authorization burdens, which will have dire consequences for both patients and physicians.
By continually reducing reimbursement rates, Medicare is requiring doctors who are already stretched far too thin to do more with much less. Despite the astounding fact that Medicare physician payments have declined by 33% in real terms since 2001, Congress’s continued inaction will leave doctors with even fewer resources to care for patients.
America’s physicians are struggling to stay afloat. At my six-physician ear, nose and throat practice in Louisville, Kentucky, we’re struggling to remain financially viable despite an ever-increasing patient volume. While Medicare reimbursement has stagnated over the past 20 years, our practice costs have risen substantially. This has forced us, at times, to cap wages for our long-term dedicated staff members, only to watch them leave healthcare altogether for industries that can pay them more.
Medicare has utterly failed to keep physician reimbursement anywhere close to inflation-driven increases in the costs of running a practice and providing care to patients. The latest cut comes as the cost of providing care, as measured Medicare Economic Index, is set to increase by 3.5% this year.
Making matters even worse, insurers frequently tie their physician contracts to the MPFS. This, combined with the fact that Medicaid payment in most states is also based upon a percentage of Medicare, creates an unsustainable situation for many physician practices, particularly private practices like mine. Physicians have been forced to make difficult choices – in some cases limiting the number of Medicare patients they see, not accepting new Medicare patients or closing their practice altogether. In each case, it’s patient access to care that suffers.
With the window to address this year’s cut rapidly closing, lawmakers must prevent a further erosion of America’s supply of physicians and ensure that patients can continue to access top-notch, timely care. Congress must immediately reverse the latest cut and provide an additional positive update to the MPFS to account for inflation. Reform that adjusts physician reimbursement annually based on the Medicare Economic Index, as is already the case with Medicare reimbursement to nearly all other providers, would be a logical next step once the immediate problem is addressed.
In addition, Congress must pass long-overdue legislation to reform prior authorization, which has become a major burden for patients and physicians. Nearly one-in-four doctors say prior authorization has led to a serious adverse event (PDF) for their patients like hospitalization or even death. Moreover, 95% of physicians report that the process “somewhat or significantly” increases physician burnout, and most insurance denials are ultimately overturned on appeal, underscoring the time wasted in this deeply flawed process.
The Improving Seniors’ Timely Access to Care Act would address this broken system, has enjoyed bipartisan support, and was projected by the Congressional Budget Office to have no significant effect on the national budget. Congress must finally pass this bill to provide prior authorization transparency and ensure that healthcare decisions are made by patients and their physicians—not by Medicare Advantage plans. Doing so would help prevent dangerous delays in patient care and allow physicians to focus more time and resources on treating patients.
It’s time for lawmakers to put our healthcare system on a more sustainable path for patients and physicians. While ensuring fair Medicare reimbursements and streamlining prior authorization won’t solve all the problems with our healthcare system, they will seriously improve two major causes of widespread physician burnout and the catastrophic doctor shortage. Ultimately, this will expand patient access and help ensure Americans don’t have to wait months to see their doctor.
Bruce Scott is an otolaryngologist in private practice and president of the American Medical Association.
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