GOP doctors fume over Medicare pay cuts but see only partial fix

The best that physicians can hope for to repair the latest proposed cuts to the Medicare fee schedule is a short-term fix, said members of the House Republican Doctors Caucus Friday as they fumed that their private sector colleagues have been left out in the cold by the federal government.

The Centers for Medicare and Medicaid Services in July proposed a 2.9% cut in the 2025 physician fee schedule, which was widely decried by physician groups. They have called on Congress to rescind the planned reduction and address the underlying problems that have been causing the cuts every year.

Related: Another Medicare pay cut looms for physicians

Members of the GOP Doctors Caucus speaking to reporters about their priorities for the end of the year and beyond said they have heard their medical colleagues. But they could not promise any dramatic fixes. 

"I think we're looking at a short-term fix," said Rep. Dr. Larry Bucshon (R-Ind.), who noted with regret that last year Congress only managed to undo part of that year's fee schedule reduction, which he said could have been easily erased.

"With all the money that Congress spends, we can't pay our doctors properly. I mean, the last time, to get a full fix would have cost an additional $1.8 billion," Bucshon said. "That's a rounding error in Washington, D.C."

Physician pay is only one of numerous healthcare problems that Congress has tried to address during this session. Bills focused on transparency throughout healthcare, the role of pharmacy benefit managers, healthcare consolidation and other issues have gained some traction over the last year and a half, but have not become law. 

Many lawmakers beyond the Doctors Caucus in this Congress have been hoping to include their priorities in a large healthcare package, but when such legislation came within sight last year, its proponents were unable to overcome the broader fights over federal spending.

Lawmakers are again eyeing a year-end package, but with even a partial fix for doctor pay remaining uncertain, the GOP doctors were not optimistic of significant progress, though they argued they at least had elevated the topic. 

"I don't know that it necessarily can be achieved in this environment, this term," said Rep. Dr. Brad Wenstrup (R-Ohio). "I think we certainly have set the stage, and we're trying right now to make a change in the conversation."

One such bill is the Provider Reimbursement Stability Act of 2023, which would change so-called budget-neutrality rules in Medicare that require CMS to makes cuts, often to doctor pay, if costs elsewhere in the program rise by more than $20 million. Other proposals are the Physician Fee Schedule Update and Improvements Act of 2023, and the Strengthening Medicare for Patients and Providers Act of 2023, both of which would modify how pay adjustments are calculated.

Other GOP caucus members said the status quo was simply unacceptable. 

"One of the biggest things that I hear every single day from my colleagues is that we keep, as physicians, getting cut, cut, cut," said Rep. Dr. Greg Murphy (R-N.C.), pointing to information from the American Medical Association and other data that show physician pay under Medicare would be nearly 30% lower than it was 20 years ago, adjusted for inflation, under the current proposals.

"We are destroying our doctor base in this country," said Rep. Dr. Michael Burgess (R-Texas). "We wore them out with COVID. At the end of that, we said, 'OK, good. Here's your pay cut.' And they said, 'Wait, what? I'm out of here.'"

Rep. Dr. Richard McCormick (R-Ga.) said the ongoing pay cuts were leading not just to physician shortages, but spurring consolidation.

"If you want to continue to cut pay for doctors, you will consolidate the healthcare so that only hospitals can run the healthcare system, and only PBMs make the record profits every single year," McCormick said. "We have a problem."

On the Senate side of the Hill, lawmakers have agreed that physician pay needs to be reformed. 

The Senate Finance Committee, which oversees Medicare, issued a bipartisan white paper earlier this year asking for proposals to address declining physician pay. 

"The way Medicare pays doctors for their work has not kept up with the times, and if it’s not working for doctors, it’s not working for the patients they help,” Finance Committee Chair Ron Wyden (D-Ore.) said at the time.

But as the House doctors noted, the prognosis for a fix this year is not good.