A health care provider gives assistance to a patient undergoing a mammogram in a doctor’s office. (Getty Images)
When I was a member of the Idaho House of Representatives, I focused on finding common sense conservative solutions to problems facing everyday Idahoans. The same approach is also important for our leaders in Washington, D.C.
If there’s one policy area that could benefit from common sense reform, it’s Medicare’s broken physician payment model. In the coming years, the issue will have an outsized impact on our citizens, especially those seniors in rural parts of our state — either for the better if we solve it, or the worse if we don’t. And there is no doubt we will have a crisis on our hands if something isn’t done to address physician reimbursements.
You may be surprised to learn that Medicare does not reimburse private practice physicians in the same way it does other health care providers, like hospice facilities, for example. While most providers receive automatic inflation adjustments to their Medicare reimbursement rates each year, private practice physicians do not.
As you can imagine, this small distinction makes a huge difference. Since 2001, the cost of running a practice has gone up nearly 60%. However, physicians’ Medicare payments have come nowhere near keeping up, rising just 10% during that same period. And yet, Medicare payments for inpatient hospital and outpatient hospital visits have increased around 80%. How is this fair to hardworking physicians trying to run private practices in rural communities?
We saw the most recent hit to these physicians’ bottom lines at the start of this year, when Medicare enacted a 2.83% pay cut to the 2025 Medicare physician payment schedule. My biggest concern is not just for these deserving medical professionals who are trying to keep the lights on amidst rampant inflation, but for the Medicare enrollees who rely on them.
The danger is clear; if Medicare continues to squeeze these physicians, it puts seniors’ health care access at greater and greater risk. This is especially true in the rural parts of Idaho with large concentrations of seniors on Medicare.
So, what’s the solution? This is where “common sense” comes into play. Longer term, physicians should receive the same kind of inflation-adjusted payment updates that most other providers already benefit from. But first, we could stop the bleeding by updating reimbursement rates for this year.
There is already a bill working its way through Congress that addresses the latter issue; H.R. 879, the “Medicare Patient Access and Practice Stabilization Act,” would, starting April 1, cancel the 2.83% payment cut that went into effect on Jan. 1 for private practice physicians. With support from our legislative leaders, particularly U.S. Sen. Mike Crapo, R-Idaho, this legislation could be included in the next major spending package.
If we stop there, however, we will have only kicked the can down the road another year. Applying a permanent inflation-based update to Medicare physician reimbursements could be the long-term answer we need. Yes, this will take willpower to achieve, but it is vital that we solve this issue once and for all. We should act as though rural seniors’ health care access depends on it — because it does.
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