Primary care practices across the country are being squeezed by a 35-year old provision in Medicare that has resulted in declining payments for services. In Vermont, where much of the state’s Medicaid fee schedule is based on what Medicare is paying, the impact has been worse, local providers said on Monday.
They joined U.S. Sen. Peter Welch, D-Vt., at a press conference in Williston to push for a federal bill he is sponsoring that aims to stabilize the federal government’s Medicare reimbursement schedule.
Last month, Welch joined a bipartisan slate of his colleagues — U.S. Sens. John Boozman, R-Ark., Angus King, I-Maine, Thom Tillis, R-N.C., Jeanne Shaheen, D-N.H., and Roger Marshall R-Kan. — in introducing the Physician Fee Stabilization Act. The bill would more than double Medicare’s “budget-neutrality threshold” — a provision that requires increases estimated to exceed $20 million to Medicare’s physician service fee schedule to be offset by cuts. The legislation would increase the trigger for cuts to $53 million.
“What you’ve seen is a system, in my view, where there’s an unwillingness to focus on what we need for fair reimbursement for the folks who are the least compensated, but in my view, the most important, and that’s the primary care physicians,” Welch said at a press conference in Williston on Monday.
Thanks to the budget-neutrality threshold, primary care providers are facing cuts to their Medicare reimbursement rates year over year, Welch and representatives of Vermont’s health care industry told reporters.
Jessa Barnard, the executive director of the Vermont Medical Society, said at Monday’s press conference that since 2001, providers nationwide have seen their payments for Medicare fall by 29%.
“If services are not paid for, medical practices in Vermont won’t be able to keep their doors open to serve the needs of Vermonters. Some may be forced to close altogether, while others may have to make the heartbreaking decision to limit how many Medicare patients they can see,” Barnard said. “And because we’re talking about Medicare, this means Vermonters with disabilities and seniors — some of our most vulnerable patients across the state.”
The stakes are especially high in Vermont, where many of the state’s Medicaid charges are tied to Medicare charges, including the physician fee schedule — “so when Medicare’s payments are cut, Medicaid payments are also cut,” Barnard said.
Toby Sadkin is a primary care doctor from St. Albans and the chair of Primary Care Health Partners, a group of privately owned primary care offices with locations throughout New York and Vermont. She told reporters on Monday that in some of the group’s practices, Medicare and Medicaid patients account for roughly 60% of their total patients.
“Unlike other businesses, we cannot simply increase our prices when our costs go up,” Sadkin said. “When we agree to participate in Medicare and Medicaid, we agree to accept their payments. We agreed to participate even with low reimbursement rates, because we are passionate about taking the best care of our patients.”
But eventually, the doctors said, if the numbers don’t add up anymore, practices may have to turn away Medicare and Medicaid patients, or close their doors altogether. And the supply of primary care doctors in Vermont is not keeping up with demand, according to Anne Morris, a primary care doctor in Milton and the residency director of the University of Vermont’s Department of Family Medicine.
“Unfortunately, there are many headwinds working against us,” Morris said Monday. “Physicians are aging faster than we can train new clinicians. High student loan debt and high paperwork burdens make primary care look unattractive to students. And on top of that, low and declining payments for primary care make keeping an office open difficult.”
According to Morris, what that translates to for Vermonters is: “It’s hard for everyone to find a new primary care clinician, but even harder if you have Medicare.”
The downstream effect of Vermonters not being able to attain primary care, Morris and Sadkin said, is that Vermonters are increasingly relying on urgent care or emergency room visits to get acute medical attention. Oftentimes, Morris said, the acute medical situations could have been treated earlier, more effectively and more affordably if only a patient had received preventative care.
“This is a problem that we see every day,” Morris said. “It’s definitely something that we are seeing happen more and more frequently. Our urgent cares and our ERs are very capable of reaching out to primary care offices and saying, ‘This is someone that absolutely needs to be seen soon for follow up.’ But the reality is, is that our practices are full, and the access to that care is often — if it needs to be within 24 hours, often can’t be met for several days beyond that.”
Read the story on VTDigger here: Welch and Vermont doctors tout new Medicare bill to increase payments to primary care.