An important date is looming for our nation's physicians. No, it is not Election Day, although, to be sure, that date is also important. The date I have in mind is the release of the final rule for Medicare’s physician fee schedule. The proposed rule, which was released in July, showed an across-the-board cut for America’s doctors. The comment period on this rule closed in the middle of September. The Centers for Medicare and Medicaid Services will issue a final rule around Nov. 1 regarding what the nation's doctors can expect for Medicare reimbursement next year, beginning Jan. 1. Unfortunately, all signs point to a reduction in Medicare payments for the nation's doctors. As a physician and a former member of Congress I have spent my career working to ensure patients can access the care they need from local doctors that they know and trust. But one of the greatest threats to that mission is our nation's growing physician shortage. The federal government estimates a shortage of 140,000 physicians in 2033. The workforce crisis is particularly acute in rural America. One clear driver of this nationwide physician shortage is the flawed Medicare payment policy. As the largest payer in the United States, Medicare has long failed to provide stable or predictable reimbursements to the independent doctors providing care to seniors and Americans with disabilities. Over the last 25 years, Medicare reimbursement to physicians has declined by 33 percent after accounting for inflation, while the cost of running a medical practice has continued to rise unabated. If left unchecked, these financial pressures will continue to force physicians to limit the number of Medicare patients they can see. This could lead to mergers with large healthcare systems, and many physicians will choose to simply close their practices. The “Patients First Act” (HR 9693) offers a promising and much needed fix. Sponsored by leaders of the GOP Doctors Caucus, this bipartisan legislation would make welcome changes to Medicare’s reimbursement policy for doctors. One of the most impactful improvements would provide physicians with a permanent annual payment update tied to the Medicare Economic Index — MEI — to better reflect the rising costs of delivering care. This is especially important in rural communities with limited facilities. The legislation would also modernize the outdated budget neutrality policies to provide greater stability and predictability in future Medicare physician fee schedule payments. The bill would also embrace a smarter approach to value-based care by building on the Medicare Access and Chip Reauthorization Act, which I authored. While the intent of the original MACRA legislation in 2015 is still the same, improving Americans’ access to high-quality cost-effective care, the time has come for straightforward updates to make it easier for physicians to take part in value-based care. As a physician I know the strength of our healthcare system depends upon the doctors who care for our patients every day. As a former member of Congress, I recognize that Congress has a responsibility to ensure Medicare policies support physicians rather than drive them out of practice. The reforms of the “Patients First Act” would strengthen the physician workforce and preserve independent practices. And this will help ensure patients, particularly those in rural and underserved communities, can continue to access high-quality care close to home. The release of the agency rule for the physician's fee schedule is not necessarily the end of the story. Congress has an opportunity, in fact an obligation, to act prior to the Jan. 1 enactment date. Congress could override the agency with legislation, and they should exercise that authority. It has been a long-standing concern of mine that Congress has relinquished too much power to the executive branch in decisions that rightly belong to the People's House. Consequently, Congress can adopt legislation between the time that the fee schedule is released and its ultimate enactment. In that two-month period, Congress could pass legislation that would blunt the effects or arrest the proposed cuts in the physician fee schedule. It is well past time for Congress to assert its Article l authority under the Constitution and not simply allow the administrative state to set all the rules that the rest of us must follow. Bills like the “Patients First Act” will make clear that Congress intends to be involved in this process and not simply relinquish legislative authority to bureaucrats at CMS. Congress should pass the “Patients First Act” to create that more stable environment in the Medicare payment system and reclaim its role as advocates for patients and independent physicians across the country. Dr. Michael Burgess, R-Texas, is a physician, former member of Congress and a Distinguished Fellow at the Institute for Policy Innovation.
