With a looming Medicare physician pay cut of 3.37% in 2024, alarming rates of physician burnout, and the passage of unsafe scope of practice expansions, medicine is not just at a crossroads. It is in crisis, and physicians must press for a more sustainable system that preserves patients’ access to high-quality physician care.
“It has to be us—because we experience the realities of a broken health care system each and every day,” said AMA President Jesse M. Ehrenfeld, MD, MPH, during his speech at the opening session of the 2023 AMA Interim Meeting in National Harbor, Maryland, just across the Potomac River from Capitol Hill. (Read Dr. Ehrenfeld’s speech.)
“Our voices, our stories, and our experiences are powerful ones—and we must amplify them to shine a light on what is truly happening in our health care system,” said Dr. Ehrenfeld, who shared how his own parents have been affected by Medicare’s broken physician payment system.
His parents, both in their 70s and with “a number of age-related ailments,” have struggled to receive primary care because the woefully inadequate Medicare physician payments, which are not indexed to inflation, are not enough to sustain a growing number of practices.
“Too many seniors, like my parents, have gotten the same letter,” Dr. Ehrenfeld said of notices that practices are closing or ceasing to provide services for Medicare patients. “This usually leads to a frustrating and frantic search for a replacement and too often causes harm, as delays occur, things get missed in the transition, and patients often end up having to travel farther to receive necessary services.”
The looming Medicare payment “cuts are too deep, too relentless, and they touch too many lives—physicians and patients alike,” Dr. Ehrenfeld said. “We must keep the pressure on. And we will.”
Leading the charge to reform Medicare pay is the first pillar of the AMA Recovery Plan for America’s Physicians.
The AMA has challenged Congress to work on systemic reforms and make Medicare work better for you and your patients. Our work will continue, fighting tirelessly against future cuts—and against all barriers to patient care.
Message to Congress: sent
At Dr. Ehrenfeld’s urging, delegates in the hall took out their smartphones to scan a QR code that was projected on video screens. This took them to the Fix Medicare Now website where they clicked on the “Take Action Now” button, allowing them to directly email their congressional representative and demand that they support the Strengthening Medicare for Patients and Providers Act.
The bipartisan House bill is one that, Dr. Ehrenfeld noted, “would do what the AMA has long advocated for—link the Medicare physician payment schedule to the Medicare Economic Index.”
“We’re going to send Congress a message—tonight, right now, and tell them: Enough is enough,” he said.
When adjusted for inflation, Medicare physician payment has dropped 26% since 2001, while payments to hospitals and nursing facilities have kept pace with inflation.
“I don’t know many businesses in any industry that could withstand a 26% drop in revenue and still survive—much less an industry like ours that is so essential to the health, vitality and economic well-being of our nation,” said Dr. Ehrenfeld, a senior associate dean, tenured professor of anesthesiology and director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.
Some steps toward recovery
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Dr. Ehrenfeld cited recent successes in other aspects of the AMA Recovery Plan for America’s Physicians, such as tackling prior authorization and fighting scope creep. These positive steps include:
- New regulation from the Centers for Medicare & Medicaid Services that right sizes prior authorization in Medicare Advantage plans and ensures continuity of care while improving the transparency of the process.
- Seventy-two health systems, hospitals and medical groups were honored this year by Joy in Medicine™ Health System Recognition Program, which highlights organizations that have taken key steps to address the systemic causes of physician burnout.
- AMA advocacy, in coordination with state medical associations and national specialty societies, helped defeat more than 85 inappropriate scope-expansion bills in state legislatures this year.
On the scope of practice front, Dr. Ehrenfeld recalled his testimony before a House Veterans Affairs Committee panel regarding the Department of Veterans Affairs’ Federal Supremacy Project that threatens to override state scope of practice laws and lower the quality of care that veterans get.
“At that hearing, I sat next to an optometrist who, on the record, referred to himself as a physician,” Dr. Ehrenfeld said, to groans of disbelief in the crowd. “It was another outrageous reminder of why we need to continue to push back against these expansions. And why we need to lift up physicians as leaders of health care teams.”
Despite the headwinds on Capitol Hill, in state capitols and the U.S. health system’s major challenges, Dr. Ehrenfeld said physicians cannot lose hope.
“On all of these issues, I continue to be guided by a sense of optimism and purpose because I see the real progress that we have made,” Dr. Ehrenfeld said.
“I see the capacity of everyone in this room to force change that makes a real difference in the lives of patients and physicians,” he added. “It has to be us, because—despite ongoing efforts to undermine faith in science and medical institutions—people still trust and believe their physicians.”
After concluding his remarks to a standing ovation, Dr. Ehrenfeld led delegates in the hall in a chant of “fix Medicare now” as they held aloft signs with that slogan and “ensure access to care,” among other reasons why Medicare payment reform is essential.
Read about the other highlights from the 2023 AMA Interim Meeting.
