(The Center Square) – Stability for physicians and patients is sought through a North Carolina congressman’s proposal updating Medicare’s fee schedule for the first time since its establishment in 1992.
U.S. Rep. Dr. Greg Murphy, R-N.C., a practicing urologist, ran the bill in the 118th Congress and on Tuesday said he would try again. The Provider Reimbursement Stability Act, Murphy says, will help halt the shuttering of doctor’s offices across the country where the causes are increased medical costs and “persistent cuts” to their reimbursements.
“With expenses for providing care continuing to rise, declining payments are forcing many doctors into retirement, to stop seeing Medicare patients, or to sell out to consolidated hospital systems, private equity, or even insurance companies just to keep practicing,” Murphy said. “As a result, access to care in rural and underserved communities is drying up. In an era of a shortage of physicians, we cannot lose good doctors to these ever-increasing pressures. By updating the Medicare Physician Fee Schedule reimbursement policies, we can protect private practice and ensure access to affordable, high-quality care across the country for generations to come.”
North Carolina’s 100 counties are a roughly 80-20 split rural and urban. Nearly 70 of them are considered medical deserts due to the lack of primary-care providers.
If passed, the legislation would:
• Increases the budget neutrality threshold from $20 million to $54.3 million and indexes the threshold to the cumulative percentage increase in the MEI every five years.
• Provides for budget neutrality corrections related to the estimated utilization of codes.
• Provides updates to direct costs used to calculate practice expense relative value units not less often than every 5 years.
• Limits year-to-year variance in the conversion factor by 2.5%.
The American Medical Association is on board with the proposal.
“Economic forecasting is a dicey proposition,” said Dr. Bobby Mukkamala, president of the American Medical Association. “So, when CMS makes a forecast for the initial utilization of a new Medicare service, sometimes that forecast turns out to be inaccurate once claims data become available. There’s no reason that patients and physicians should have to bear the brunt of that miscalculation.
“This bill allows for a recalibration so that unnecessary cuts can be avoided. That’s good budgeting and good medicine.”
