Jason Goldman, MD, a solo internist in Coral Springs, Florida, greets his patients—about 20 to 30 each day—in the waiting room and walks them to the exam room himself. He personally calls every patient with their laboratory results.
He has two staff members at the front desk checking patients in and out, handling the referrals, taking messages and answering the phone. He has an office manager who does more than should be required and two medical assistants who help with blood draws, EKGs, administering vaccines and the like.
Dr. Goldman and his staff work hard to get his patients the care they need in an environment that is welcoming and warm.
What patients don’t see is the real worry that Dr. Goldman carries—as do so many other physician practices across the country, which is this: How can I keep the practice going financially as I face yet another year with a cut in Medicare payment?
“The patients don't feel it. They don't necessarily care until there are no doctors left,” said Dr. Goldman, an AMA member. “Because doctors want to take care of patients, we're going to continue to do what we can to make sure our patients get taken care of, whether that's having a more lean and efficient practice, whether that is working more hours, whether that's sacrificing our own health and well-being to make sure the patient's taken care of.”
But “unfortunately, it gets to a point where the balance is so off that physicians will not be able to” continue doing so, said Dr. Goldman, who is president-elect of the American College of Physicians and represents that medical association in the AMA House of Delegates.
For some physicians, that point has already passed. For all physicians, that breaking point continues to inch closer and closer with each pay cut, which is why fixing the broken Medicare payment system is the top advocacy priority for the AMA.
Following AMA advocacy in leading the charge to reform the Medicare payment system, a bipartisan majority of the House of Representatives—233 members—wrote leadership demanding that there be a positive 2025 Medicare payment update for physicians in the year-end omnibus bill. That was followed by a bipartisan group in the U.S. Senate.
Tragically, Congress ultimately passed a temporary government-funding measure that left physicians seeing a 2.83% cut for 2025 in the Medicare payments that help them support their practices and care teams and ensure access to high-quality care, especially in rural and undeserved areas.
The latest cut comes as the Centers for Medicare & Medicaid Services (CMS) projects another 3.5% rise in the Medicare Economic Index, which measures the cost of running a medical practice.
These cuts in the face of inflation have been taking place year after year, with this year marking the fifth straight year of cuts in Medicare pay. AMA research shows that Medicare physician payment, when adjusted for inflation, has dropped by 33% since 2001.
“Sometimes you can only squeeze so much blood from a stone before there’s nothing left and the practice has to close,” Dr. Goldman said, noting that all of these financial pressures on physicians who just want to care for patients also leads to burnout and decreased wellness for doctors.
The AMA is strongly encouraging physicians from around the country to come out in force for the AMA National Advocacy Conference in Washington, D.C., in February. The goal is to show Congress the real-life impact of the broken Medicare payment system on patients and on physician practices and the communities across America that doctors serve. Learn more and register now.
At a breaking point
Dr. Goldman’s patient mix is about 50% Medicare patients and 50% patients with other payers. But what many don’t realize is how Medicare payment affects what private insurers are willing to pay.
And one unusual thing about the part of the country where Dr. Goldman practices is that for many physicians, Medicare is the highest payer. For example, Medicare pays 100% of a fee and other insurers then pay 70% of that fee schedule. When Medicare then lowers their payment by 2%, 3% or 4%, physicians then also are paid less from Medicare and other payers. And that’s not even factoring in how practice costs rise with inflation each year.
“That's why we see almost the corporatization of health care, where physicians can't afford to keep their doors open so they join hospitals, other systems, which are just churning out patients and not necessarily providing that care,” Dr. Goldman said. “Quite honestly, I don't know how I continue to survive. It's exhausting. I get up every morning, I'm in the office by 7:30, I start seeing patients at 8. My gym time from 12 to 1, instead of lunch … But after that, back to patients, phone calls, administrative burden. My day is packed second-to-second.”
He said he’s managed to balance the stress because he loves taking care of patients. But Dr. Goldman asks himself: How long is this sustainable?
“While hope is not a plan, I hope that the government will eventually realize that we are in crisis and have been telling them this for years, and that they will say, ‘You're right. It's not fair,’” he said.
“We are in crisis. We need to actually stabilize payments, bring it to reasonable, appropriate levels, and build from there.”
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Dr. Goldman said he doesn’t want to contemplate a point in time where he must join a larger health system that he has no desire to join and he doesn’t want to be forced to close his doors and retire early.
“I love taking care of patients,” he said. “If Congress doesn’t fix it [the Medicare pay system], that could be a reality for me as it has been for many others.”
Fix Medicare now
Bipartisan bills that the AMA supports were introduced in the last session of Congress to make bigger, longer-term fixes to the nation’s largest single health care payer in a system that is already facing widespread physician shortages that threaten patient access to care:
- The Strengthening Medicare for Patients Provers Act would give physicians an annual Medicare payment updated tied to the Medicare Economic Index.
- The Provider Reimbursement Stability Act would reform the Medicare payment schedule budget-neutrality policies by, among other things, requiring that CMS reconcile inaccurate utilization projections based on actual claims and prospectively review the conversion factor accordingly.
The AMA will be working to have similar legislation introduced in the current session of Congress. The AMA also has a statutory proposal to replace the Medicare Incentive-based Payment System’s (MIPS) tournament model of payment adjustments with a more sustainable approach tied to annual payment updates. The “Data-Driven Performance Payment System,” which the AMA developed with substantial input from national medical specialty societies and physicians nationwide, also would give CMS incentives to share data with physicians and improve the measures.
Learn more with the AMA’s Medicare Basics series, which provides an in-depth look at important aspects of the Medicare physician payment system. With six straightforward explainers on budget-neutrality rules, MIPS, the Medicare Economic Index and more, policymakers and physician advocates can learn about key elements of the payment system and why they are in need of reform.
“It's not a matter of doctors trying to make more money. It's about doctors trying to keep their doors open, keep the lights on, pay good staff,” Dr. Goldman said. “We need to be paid fairly. ... They have to stop putting physicians against each other. And we, as physicians, need to take a step back, recognize what they're doing to us, and say, ‘Enough is enough,’ and we all need to stand together. … We love what we do. We love taking care of patients, but it's harder and harder to do that.”
