Rheum Leaders on Capitol Hill Advocating for Medicare Payment Reform Save

On May 7th, the American College of Rheumatology (ACR) hosted its annual Capitol Hill fly-in with rheumatology leaders nationwide to champion the need for crucial reforms to the Medicare Physician Fee Schedule (MPFS). The goal is to enhance the payment system’s predictability and stability, ensuring continued access to care for patients by adequately supporting healthcare providers.

“Physicians have consistently faced reductions in Medicare reimbursement rates while grappling with escalating operating costs,” said Deborah Desir, MD, president of ACR. “We are here to convey to lawmakers that this growing imbalance with the Medicare Physician Fee Schedule has reached a critical point for many healthcare providers, necessitating immediate Congressional action.”

“I have long fought to ensure providers are properly supported as they care for America's Medicare beneficiaries,and I appreciate the American College of Rheumatology and advocates from the broader rheumatology community for joining me to advocate for reimbursement that assures appropriate care for America's seniors,” shared Congressman Larry Bucshon, MD (IN-08), who will be addressing attendees as part of the event.

ACR is advocating for legislation addressing two persistent challenges impacting MPFS: inflation and a mandatory budget-neutrality requirement.

Most healthcare providers, like hospitals and skilled nursing facilities, have seen their Medicare payments keep pace with rising costs thanks to a conversion factor that ties their payment to inflation rates. However, this conversion factor is not extended to physicians, who have seen their payment rate decline over 25% since 2001 when adjusted for inflation. ACR supports the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would address this disparity by adding a permanent annual inflationary update for Medicare physician payments.

The MPFS is also restricted by a budget neutrality requirement enacted in 1989 that mandates payment adjustment increases of $20 million or more be offset by other payment cuts. This unpredictability, combined with the decline in rates, impacts providers’ financial planning ability and incentivizes consolidation, reducing time spent with patients or opting out of Medicare payment altogether, limiting Medicare patient access to care. The Provider Reimbursement Stability Act (H.R 6371) would help to curtail the negative impact of budget neutrality requirements by raising the budget neutrality threshold from $20 million to $53 million and requiring its regular re-evaluation.

“Physicians are the foundation of the Medicare system, but rising costs, administrative burdens, and declining payment rates are challenging that foundation like never before. We urge Congress to enact these measures to provide relief to physicians and ensure continued patient access to high-quality healthcare,” Dr. Desir concluded.