Will Congress Step Up to Save Primary Care?

Tochi Iroku-Malize, MD, MPH, MBA, FAAFP; Sterling N. Ransone, Jr., MD, FAAFP; Steven P. Furr, MD, FAAFP


November 09, 2022

Tochi Iroku-Malize, MD, MPH, MBA, FAAFP

Primary care and family physicians operate on the frontlines of healthcare, working tirelessly to serve patients and their families. However, many primary care practices are operating on tight margins and cannot sustain additional financial hits. As we continue to navigate a pandemic that has altered our healthcare landscape, we traveled to Capitol Hill to urge Congress to act on two critical issues: Medicare payment reform and streamlining administrative burden for physicians.

The current Medicare system for compensating physicians jeopardizes access to primary care. Family physicians, along with other primary care clinicians, are facing significant cuts in payments and rising inflation that threaten our ability to care for patients.

Sterling N. Ransone, Jr., MD, FAAFP

Each of us has experienced the effects of this pincer in devastating ways — from the independent clinicians who have been forced to sell their practices to hospitals or large health systems, to the physicians who are retiring early, leaving their practices, or even closing them because they can't afford to keep their doors open.

Practices also struggle to cover the rising costs of staff wages, leasing space, and purchasing supplies and equipment, leaving little room for innovation or investments to transition into new payment models. Meanwhile, hospitals, skilled nursing facilities, ambulatory surgery centers, and other Medicare providers receive annual payment increases to account for rising costs.

Steven P. Furr, MD, FAAFP

Insufficient Medicare payments also challenge practices that serve many publicly insured patients. If practices cannot cover their expenses, they may be forced to turn away new Medicare and Medicaid patients — something that goes against the core tenets of our healthcare system.

Fortunately, we have some solutions. We're asking Congress to pass the Supporting Medicare Providers Act of 2022, which calls for a 4.42% positive adjustment to the Medicare Physician Fee Schedule (MPFS) conversion factor for 2023 to offset the statutory reduction triggered by budget neutrality rules.

We also are calling on lawmakers to end the statutory freeze on annual updates to the MPFS and enact a positive annual update to the conversion factor based on the Medicare Economic Index. This critical relief would stave off the most immediate cuts while giving us more time to work with Congress on comprehensive reforms to the Medicare physician payment system.

As many practices struggle to operate, burnout among primary care physicians has also increased, with research showing that 66% of primary care physicians reported frequent burnout symptoms in 2021. Streamlining prior authorizations — a cumbersome process that requires physicians to obtain preapproval for treatments or tests before providing care to patients, and can risk patients' access to timely care — is one way to reduce burden and alleviate burnout.

According to the American Medical Association, 82% of physicians report that prior authorization can lead to patients abandoning care, and 93% believe that prior authorization delays access to necessary care.

All of us have had patients whose care has been affected by these delays, including difficulty in getting necessary medications filled or having medical procedures postponed. Moreover, primary care physicians and their staff spend hours each week completing paperwork and communicating with insurers to ensure that their patients can access the treatments and services they need.

That is why we're urging the Senate to pass the Improving Seniors' Timely Access to Care Act, which would streamline the prior authorization process in the Medicare Advantage program.

As family physicians, we are in a unique position to help improve our patients' health and their quality of life. But we can't do this alone. We need the support of policymakers to make patient health and primary care a national priority.

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