Health Subcommittee Holds Hearing Examining Medicare Physician Payment Issues and Reforms Enacted in MACRA
WASHINGTON, D.C. – Today, Congressman Morgan Griffith (VA-09), Chairman of the Subcommittee on Health, led a hearing titled Examining the Medicare Physician Fee Schedule, MACRA, and Opportunities for Payment Reforms.
“Our discussion today built on the Affordability Series that we have been working on throughout the year and allowed us to better understand how provider payment challenges can impact health care affordability,” said Chairman Griffith. “Physicians, nurses, and other health care providers are critical to our health care system, and their work remains essential to ensuring patients have access to timely, high-quality care in every community. Maintaining a stable and sustainable physician payment system is important not only for supporting providers, but also for preserving competition, affordability, and access to care for patients.”
Watch the full hearing here.
Below are key excerpts from today’s hearing:
Congressman Gus Bilirakis, (FL-12): “How does the current Medicare reimbursement structure affect the ability of independent practices to staff appropriately, invest in technology, and continue offering quality services to patients?” Dr. Snyder: “It’s making it very challenging to maintain an office or staff. Frequently, our staff are looking—it’s always greener on the other side—our staff are going to other hospital-employed models because they can offer more because of reimbursement [because] there is more. And it’s having a significant impact on our ability to see as many patients in the office as we as we would like to.” Congressman Bilirakis: “If these reimbursement challenges remain unresolved, what would that mean for patient choice, access to community-based care, and overall health care costs? The bottom line.” Dr. Snyder: “If these go unabated, we are experiencing what I like to affectionately call the “Our-physicians-are-entering-the-physician-transfer-portal,” and going to a hospital employment. And frequently, their patients will follow them, but we see they come back. Because, “Yes, I wanted to follow Dr. Jones, I've known him for a long time. We have a very good relationship. But when I went to go get my annual test, my annual echocardiogram or guideline indicated stress test, it is two to three times the cost.” And they're on the hook for that, and they will come back frequently.” Congressman Bilirakis: “So, there’s no patient choice in a lot of cases.”
Congressman John Joyce, M.D. (PA-13): “Dr. Fox, you stated specifically, in your area in Virginia, that you have seen independent primary care practices being bought up by hospital systems. Do you feel that when that occurs, the ensuing vertical integration leads to less personalized care, less access for the seniors who, as I said, paid into this Medicare system for their entire working lives?” Dr Fox: “I do, Dr. Joyce. I’m seeing vertical integration occurring all around me, and I have for the last several decades, as practices in my community are being sold to private equity or being acquired by the health care system.” Congressman Joyce: “Delve into that a little bit more. Once we're sold to a private equity firm, do you find the physicians have less time to spend with their patients?” Dr. Fox: “Well, we know from studies that vertical integration leads generally to higher costs.” Congressman Joyce: “Do you feel that it affects the ability of the physician—you, the physician sitting across the table from this patient, to refer them to the best specialists, the best hospital facility, the best laboratory, the best radiologic facility? Does that impact on that?” Dr Fox: “My colleagues share with me that there are enormous pressures placed upon them when they are in large health systems or in private equity, that there are pressures to be more productive.”
Congresswoman Mariannette Miller-Meeks (IA-01): “As someone who’s dedicated their professional life to the practice of medicine, the issue of payment reform is, in my opinion, the most critical issue for physician stability and the long-term viability of our health care workforce, and especially, as in my state, rural health care. The Medicare Physician Fee Schedule was intended to create stability and predictability. Instead, physicians have faced years of uncertainty, repeated payment cuts—actually, on an annual basis—and growing administrative burdens. At the same time, the cost of delivering care continues to rise. If we continue on this current path, we are not just cutting payments, we are cutting patients access to local care they know and trust.”
