09/21/2023
On September 11, 2023, I had the opportunity to participate in a physician roundtable in Crystal City, Missouri with House Ways and Means Chairman Jason Smith with a frank and open exchange of ideas on the healthcare access crisis in rural America and possible solutions. I made the point that the physician shortage, 46% for primary care and 90% for specialists in rural areas, is the canary in the coalmine of challenges we are starting to face in all of the U.S. if the Medicare quarter-century physician payment freeze in nominal terms and 26% cut in real terms is not solved now! The relentless squeeze on physicians’ part of reimbursement has, is and will continue to accelerate the closing of independent practices, early physician retirements, physicians not accepting new Medicare patients, physicians dropping out of Medicare altogether and consolidation with physician practices being absorbed by hospital systems with their 5-fold+ higher reimbursement rates for identical services. The perverse outcome of reduced physician reimbursement is care that moves from the most cost-effective, efficient setting – the physician’s office – to the most expensive, cumbersome and inefficient hospital setting resulting in far higher overall cost with reduced access to care. The worst of both worlds! Hospitals are crucial for emergency, acute care, and inpatient services for serious medical conditions. The physician’s office is the optimal setting for taking care of outpatient medical care and chronic conditions. Physicians are best set up to manage patient care to keep the patients stable and out of the very expensive hospital setting.
The Chairman seemed very receptive to proposals that would support independent physician practices through adequate reimbursement, especially primary care practices in rural areas to preserve and improve access for our most needy patients, reduce unnecessary regulations that impede good patient care and allow physicians to focus on what they do best – taking care of their patients.
