Should doctors get a pay cut? House members wrangle over Medicare payments for 2024

The Centers for Medicare & Medicaid Services wants to hold the line on expenses, while physicians want to be fairly compensated for their services. Resolving the conflict will not be easy, as a congressional hearing last week demonstrated.

A House Energy and Commerce subcommittee held last week discussed 23 bills or drafts that address how Medicare pays providers. Some draft bills focused on changing the payment formula CMS uses to calculate physician payments. CMS proposed a 3.3% cut to Medicare payments for 2024, the latest in a series of cuts due partly to budget neutrality rules.

Medicare payments to doctors have effectively been cut by 26% when adjusted for inflation since 2001, according to the American Medical Association. It also noted that reduced payments could lead to less access to care for Medicare recipients. If Congress doesn’t act by the end of this year, Medicare will cut payments to doctors in certain rural areas and to laboratories that run tests used in caring for patients. Multiple subcommittee members also discussed whether Medicare payments should be indexed to inflation.

Other legislation sought to rein in the use of prior authorization by Medicare Advantage plans, a cost-containment tool that requires doctors to get insurer approval before prescribing a drug or performing a service.

However, recent chaos in the House in choosing a new speaker and friction between the two parties makes a wholesale reform effort appear unlikely this year, according to Politico. Democrats on the panel were upset that some legislation wasn’t included in the bills highlighted at the hearing.

“My Republican colleagues shared a vast majority of the discussion drafts we will be discussing less than a week before the hearing was noticed,” said Rep. Frank Pallone, D-N.J. “Republicans didn’t include the Helping Low-Income Seniors Afford Care Act, which seeks to extend funding for outreach to low-income older Americans.”

Rep. Anna Eshoo, D-Calif., was upset that nearly half of the bills are “either in discussion draft form or only formally introduced a week ago.”

Related: ‘Unsustainable’: Doctors weigh in on CMS’ 2024 physician pay cut proposal

Republicans argued that the Biden administration is part of the problem, because rising inflation has exacerbated costs for practices. Committee Chair Cathy McMorris Rodgers, R-Wash., added that there were no hearings for the past four years on the issue.

The American Hospital Association submitted a statement to the committee in support of legislation that would streamline prior authorization and certain alternative payment model requirements in the Medicare Advantage program; update payment and ease reporting for Medicare clinical diagnostic laboratory services; streamline Medicare quality reporting; and prevent Medicare from publicizing a telehealth provider’s home address. However, the AHA strongly opposed any legislation that would ease growth restrictions on physician-owned hospitals.