Establishing a Sustainable Medicare System For Patients and Clinicians
The ACC is dedicated to developing and advancing solutions that will optimize the delivery of cardiovascular care, increase access to care, decrease health inequities in communities nationwide, and improve patient outcomes and health overall. To achieve this, it is crucial to both eliminate the Centers for Medicare and Medicaid Services' (CMS') proposed 2.8% reduction to the 2025 Medicare Physician Fee Schedule and to implement broader, long-term reforms to the Medicare payment system.
A History of Declining Payments and Rising Costs
Over the last 20 years, clinicians have experienced a staggering 47% increase in practice expenses, while Medicare reimbursements have drastically decreased – nearly 30% in the same period. This unsustainable system severely inhibits clinicians' ability to effectively run their practices during a time when the nation is facing a health care workforce crisis, limiting patients' access to care especially among rural, senior, and other vulnerable and underserved populations. Without immediate and substantial reform, clinicians may face difficult decisions about whether it is financially viable to keep their doors open.
Did You Know?
- Clinicians are slated to see a 2.8% cut next year as proposed in the 2025 Medicare Physician Fee Schedule, which will harm patients and practices.
- This 2.8% cut follows a pattern of cuts to Medicare reimbursement in recent years, including 2% in 2024, nearly 2% in 2023, 0.8% cut in 2022 and 3.3% cut in 2021.
- Although heart disease remains the leading cause of death among men and women across most races and ethnicities, cardiology practices can expect to see a decrease of $168 million in reimbursement if these cuts take effect in 2025, while practice expenses continue to match or rise above inflation.
Short-Term Solutions For Today
Stagnant and declining payment for Medicare services exacerbates financial uncertainty for practices and worsens disparities in care delivery. Congressional action is necessary before the end of 2024 to provide a short-term fix for the latest proposed cuts looming. Policymakers should include language in legislation to eliminate the proposed 2.8% cut to physician payment in the 2025 Medicare Physician Fee Schedule.
Long-Term Reform For Tomorrow
Short-term patches, while necessary, will not fully repair the broken and flawed Medicare payment system. Congressional action is necessary to find solutions that will safeguard patient access to care and provide greater financial certainty for clinicians for years to come.
The ACC strongly supports the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which aims to address the lack of inflationary adjustment for physician reimbursement in the Medicare payment system. Introduced by Reps. Larry Bucshon, MD, (R-IN) and Raul Ruiz, MD, (D-CA), the legislation would update the Medicare Physician Fee Schedule conversion factor to be equal to the estimated percentage increase in the Medicare Economic Index. Ensuring a built-in mechanism exists for an inflationary update would help clinicians keep pace with rising costs and remove the need for Congress to take legislative action each year to prevent annual decreases in physician payment from taking effect.
The ACC also calls on Congress to support and pass legislation to raise the current $20 million budget neutrality threshold, which has not been increased since its establishment in 1989. The Provider Reimbursement Stability Act (H.R. 6371), introduced by Reps. Greg Murphy, MD, (R-NC) and Robin Kelly (D-IL), and the Physician Fee Stabilization Act (S. 4935), introduced by Sens. John Boozman (R-AR) and Peter Welch (D-VT), both seek to increase the budget neutrality threshold to $53 million, allowing CMS to increase payments to certain specialties while minimizing reductions from others.
The ACC urges Congress to continue to work with the College along with the broader medical community in bringing more stability to the Medicare system through sustainable, long-term reforms, ensuring clinicians in all communities can continue to focus on providing the highest quality patient care.
