Family physician Arthur Apolinario, MD, MPH, set up practice in rural Clinton, North Carolina, nearly a quarter of a century ago.
He and the eight other physicians who own a primary care practice there take care of the farmers in the surrounding area who tend to the hogs and turkeys and crops that help put food on America’s tables. Many of those farmers are of Medicare age and continuing to tend to the land they love.
When you adjust for inflation since 2001, Dr. Apolinario and his partners are being paid 26% less today than they were being paid by Medicare for the same services in 2001. And physicians don’t receive the annual inflation adjustment that hospitals and all other clinicians receive from Medicare. That makes it hard to pay competitive salaries to keep office staff, and makes it difficult to recruit physicians and other clinicians.
As Dr. Apolinario and his physician colleagues across the country stare down the proposed 3.37% Medicare pay cut scheduled to take effect in January—which comes on top of a 2% pay cut in 2023 and, again, no adjustment for inflation—he worries about what it will mean for his patients and his practice. There is no one in his rural county to pick up the slack if he or his partners stop practicing medicine because they can’t afford to keep the doors open. The closest city is a 40-minute drive: Fayetteville, North Carolina, where about 200,000 people live.
“It's a threat to access, not only the access to me, but the access to the specialized care that people need—especially as they get older,” said Dr. Apolinario, a past president of the North Carolina Medical Society who represents the organization as an alternate delegate in the AMA House of Delegates. His Medicare patients already have to wait four to six months to see specialists because those physicians are opening up fewer spots for Medicare patients so that they can keep their doors open.
“But,” Dr. Apolinario said in an interview at the 2023 AMA Interim Meeting, “the biggest threat is I'm helping feed the United States. I'm taking care of these farmers and … if that farmer at the top of the farm goes away, the farm goes away. If their access to me goes away, they go away. So, it's not just me, it's keeping the infrastructure intact.”
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.
Emergency departments also hit
Emergency physician John Corker, MD, is a partner with a group of independent physicians that contracts exclusively with a large hospital system in Southwest Ohio, comprised of 13 emergency departments in settings that range from freestanding emergency departments to large academic medical centers. The group has worked hard to maintain this contract for more than 40 years, while simultaneously navigating the dynamic health care landscape and mounting challenges to maintaining independent practice. His physician group also is feeling the pinch of previous cuts and the uncertainty of the looming cuts.
“It's really hard for the little guy to keep our doors open, to recruit and retain board-certified emergency physicians that our patients deserve in our community,” said Dr. Corker, who noted that emergency physicians have the double-whammy of frequently going unpaid for services provided because of the Emergency Medical Treatment and Labor Act.
And, he noted, Medicare rates have a ripple effect on other payments that physicians get because private insurers tend to base their rates on what Medicare is paying.
“So, as Medicare continues, over the last quarter century, to lose ground as it pertains to inflation and the bottom line, our private insurance rates are also proportionately going down,” said Dr. Corker, a delegate for the Ohio State Medical Association in the House of Delegates.
Medicare’s physician payment problems are “continuing to chip away,” he added. “There's death by a thousand paper cuts. And that's what physicians are dealing with right now.”
Help cancel the cut
The AMA is fully behind the Preserving Seniors’ Access to Physicians Act of 2023, introduced in the House of Representatives last week. The measure, H.R. 6683, would cancel the entirety of the 3.37% cut, and a bipartisan group of nearly 200 members of Congress co-signed a Dec. 13 letter (PDF) urging congressional leaders to expeditiously pass legislation to address looming Medicare payment cuts.
Physicians and patients can visit the AMA’s Fix Medicare Now website to write their congressional representatives to support this critical legislation.
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