Opinion | Vulnerable Patients Are Back on the Chopping Block

Imagine if you called your local doctor, say a radiation oncologist, interventional nephrologist, or vascular specialist, and there was no one to take your call because they abruptly closed their doors. That scenario may become more and more common unless Congress acts to stop the latest round of devastating Medicare reimbursement cuts. It’s not just an inconvenience for patients — the cuts will undermine access to healthcare as well as the quality of care.

Healthcare organizations, providers, and patient advocates are ringing alarm bells about the severe cuts to office-based specialty care providers that have been proposed in the 2023 Medicare Physician Fee Schedule. The Centers for Medicare & Medicaid Services (CMS) is proposing to cut the Medicare conversion factor, the starting point for calculating Medicare payments, by about 4.5%, threatening specialty care providers’ ability to keep their doors open.

If these cuts are implemented, Americans — particularly people of color, those who live in rural communities, and the elderly — will see clinics they rely on for life-saving care disappear from their communities. This policy decision will put vulnerable patient populations squarely on the chopping block. There is no doubt that it will widen the healthcare equity gap that already exists.

Black and Latino patients suffer disproportionately from many of the diseases treated by the specialty providers who are seeing the biggest cuts, and they often live in areas where healthcare access is already limited. Services that would see large cuts under the proposed rule include treatments for venous ulcers, kidney failure, cancer, peripheral artery disease, and uterine fibroids — all of which affect Black patients at higher rates.

The new reimbursement reductions are part of a troubling trend that already includes clinical labor cuts of over 20%, which are being phased in through 2025. As a result of these cumulative cuts, many office-based providers will be subject to cuts of up to 9% in 2023 alone. In addition, since 2006, we have seen a downward spiral of cuts in the Physician Fee Schedule to office-based specialists of around 30% on average and nearly 40% for vascular specialists. This is occurring on top of the pandemic and record inflation that has compounded the damage.

As we’ve already seen, these constant cuts are leaving office-based and small healthcare providers with no other option than to either move to a hospital setting or close their doors outright. A 2018 survey by the American Society of Diagnostic and Interventional Nephrology found that reimbursement levels were so low after the 2017 cuts that more than 20% of physicians responding to the survey reported the cuts caused their centers to close.

This is contributing to a concerning trend of healthcare consolidation. According to the American Medical Association, the percentage of physicians working for a hospital increased from 29% in 2012 to 39.8% in 2020. Medicare reimbursement for specialists is now, on average, $100,000 less per physician per year when they operate in an office-based setting. This large discrepancy in pay for the exact same services gives providers a strong incentive to join the long line of professionals moving to big healthcare systems. Those who can no longer afford to operate at all under the proposed fee schedule will have to follow suit.

As a result, patients are forced to turn to those hospitals for care. Not only is hospital-based care significantly more expensive, but it also places a huge burden on patients, who may have to travel farther to see a provider, and exposes vulnerable patients to unnecessary health risks, thus decreasing the quality of care.

My patients from our city’s underserved populations continue to tell me how much they prefer getting treated in our office-based lab. We’re able to provide them with focused, dedicated outpatient care that a hospital cannot match. As long as it is safe to do so, our patients often choose to wait for an opening in the center rather than have their procedure done sooner in a hospital. If the CMS cuts go through, and our facility shuts down, we will leave many of our underserved, sick patients to find treatment in the already overburdened hospital system.

The fact is, we simply cannot afford to eliminate local physicians offices as an option for care — they are a critical part of our healthcare infrastructure.

The proposed slashes to Medicare reimbursements are set to take effect on Jan. 1, 2023, but it is not too late to act. Contact your representatives in Washington and call on them to stop continual, disastrous clinical labor cuts to specialists. It is critical to the health of the American people, including many of our patients, to save the local providers that we rely on for accessible, affordable, life-saving care.

Mark Garcia, MD, is CMO for American Vascular Associates and the health policy advisor for United Specialists for Patient Access (USPA).