Echoing a longtime call from organized medicine, Congress is considering a bipartisan bill that would tie Medicare physician payment to the Medicare Economic Index (MEI), used to calculate the cost of patient care, to create a more stable, predictable system.
H.R. 9693, known as the “Patients First Act,” was introduced by a trio of physician-legislators and, as of this writing, has garnered 50 cosponsors, including a bipartisan group of five Texas legislators. The bill was discussed at a Sept. 15 hearing on Medicare reform before the U.S. House of Representatives’ Subcommittee on Health, part of the Committee on Energy and Commerce.
TMA and the medical societies of every state plus the District of Columbia joined the American Medical Association to support the bill in a Sept. 14 comment letter.
When adjusted for inflation, Medicare physician payment has dropped 33% since 2001, according to AMA.
“Physicians remain the only Medicare provider type that does not receive an annual payment update tied to inflation,” the letter said. “This growing gap has forced many practices – particularly small, rural, and independent practices – to consolidate or limit the number of Medicare patients they serve, threatening timely access to care for millions of patients in our states.”
The proposed 2027 Medicare physician fee schedule may widen that gap. It calls for reducing the conversion factor (used in calculating physician payment) by 1.68% for most physicians and by 1.19% for qualifying alternative payment model participants – despite the Centers for Medicare & Medicaid Services (CMS) projecting a 2.5% increase in physician practice costs as measured by the MEI.
CMS would further reduce payment for certain services when a physician uses modifier 25 to document a separate evaluation and management (E/M) service on the same day as a procedure.
TMA President Bradford W. Holland, MD, sees the federal bill as “the next thing we can potentially do,” should the proposed 2027 fee schedule be finalized without addressing the concerns in TMA’s recent comment letter.
“Almost everything in Medicare reimbursement is tied to inflation except the physician payment part,” said Dr. Holland. “[CMS has] used that to sort of pretend to balance the books on the backs of physicians. We've felt the pain while everyone else gets the increases.”
Per a press release from co-author Rep. John Joyce, MD (R-Pa.), H.R. 9693 would also increase the budget neutrality threshold from $20 million to $54.3 million, which TMA supports. This would raise the cost cap on changes to the fee schedule, allowing CMS to make larger payment increases for certain services without needing to cut others
The federal bill would establish a Medicare primary care hybrid payment pilot program that pays for certain primary care services through a risk-adjusted per-member-per-month payment model. It also seeks to preserve incentives for physicians who participate in alternative payment models and would replace the Merit-Based Incentive Payment System with what AMA calls “a streamlined, clinician-driven quality program that reduces penalties and administrative burden.”
Reforms proposed in the legislation align with the Characteristics of a Rational Medicare Physician Payment System, a framework created by AMA that TMA and more than 120 organizations, including state medical associations and national medical specialty societies, have endorsed.
Dr. Holland encourages TMA members to contact their federal legislators about the importance of the legislation.
Review the recent Medicare advocacy letters TMA has written and signed on its website’s federal advocacy page
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.