January 10, 2024Peter Sullivan Axios.com January 10th, 2024 – 6:00am Congress is once again being urged to reverse a cut to physicians’ Medicare payments, prompting calls for a broader overhaul of how the program reimburses doctors. Why it matters: Congress is still stuck in an annual dance of being pressured to increase physician payments, even after Washington nearly a decade ago put an end to the despised “doc fix” that forced lawmakers to regularly forestall deep cuts. Driving the news: With the Jan. 19 government funding deadline approaching, doctors are ramping up pressure on Congress to use the next spending package to reverse cuts that took effect Jan. 1. This time, they are raising alarms about a 3.4% cut in physician reimbursements stemming from Medicare’s plan to adjust a key metric governing physician pay, known as the conversion factor, and a new billing code for complex office visits. Doctors argue it will particularly harm rural physicians who work on thinner margins, and that it compounds previous reimbursement cuts. What they’re saying: American Medical Association president Jesse Ehrenfeld told Axios the cuts are “placing enormous pressure on physicians.” Yes, but: Josh Gordon, director of health policy for the Committee for a Responsible Federal Budget, argues that doctors’ complaints are overblown, and that the cuts won’t undermine care for seniors and people with disabilities enrolled in Medicare. Medicare beneficiaries still have very good access to physicians under the current trajectory” for physician pay, he said. The bigger issue, he said, is that Washington appears to be back in the annual cycle of Medicare cutting physician pay, only for Congress to step in again, making a long-term fix reasonable if it is paid for. At the end of 2022, Congress also partially reversed Medicare cuts to doctors, though the industry at the time argued it was not enough. “It’s probably time for Congress to do a more long-term reform,” Gordon said. Zoom in: It took lawmakers years to agree on how to eliminate the flawed Medicare payment formula behind the doc fix. Any bigger reform to the current Medicare payment formula, which is based on a complex set of factors, likely wouldn’t be nearly as pricey — the 2015 reform cost $214 billion. But the politics of reforming physician pay is tricky, and policymakers have to balance concerns about the sustainability of Medicare’s finances while ensuring the program is attractive enough to providers. Doctors are often well-connected in their communities, and lawmakers hear from them when they go back home, keeping the issue prominent on Congress’s radar. Lobbyists told Axios they expect Congress will deliver some partial relief from the most recent cuts. The Senate Finance Committee, for example, approved as part of a larger November package a measure to reduce the cut from 3.4% to just over 2%. The Congressional Budget Office estimated that would cost $670 million over 10 years — not a prohibitive price tag. What’s next: The AMA is touting a bipartisan bill from a group of lawmakers who are doctors: Republican Reps. Larry Bucshon of Indiana and Mariannette Miller-Meeks of Iowa, and California Democratic Reps. Raul Ruiz and Ami Bera. Their measure would provide for annual increases for doctors tied to inflation, but it’s unlikely Congress will agree on a more comprehensive payment change like this one before the fast-approaching government funding deadline. “We’re not going to have wholesale reform by January 19, we know that,” AMA’s Ehrenfeld said. “But it’s a goal that we still hold to, because we’ve got to get off this hamster wheel of these short-term fixes every single year.”