WTF, CMS?

Listen to my podcast episode about this issue: https://healthcaremusings.substack.com/p/wtf-cms

It is that time of year, and the beloved Center for Medicare and Medicaid Services (CMS) has published its proposed Medicare Physician Fee Schedule for 2025. And, quite shockingly, they have proposed another 2.8% cut in physician fees for Medicare patients.

Like, WTF, CMS?

I am confident that some, as they read this invective, may be quick to dismiss my rant as that of a "greedy" Doctor who is crying because he is getting 3% less money. This is absolutely false. I, like many if not most physicians, am employed by a large medical group and am salaried per shift I work.

Yet, even if this reimbursement cut goes through as proposed and my employer graciously does not pass along the cut in the form of salary reductions, it still placed financial pressure on medical groups such as ours. Our expenses keep increasing, and the reimbursement from CMS keeps decreasing.

This is simply unsustainable.

And for small medical practices across the country, who are unable to absorb continued decreases in reimbursement for seeing Medicare patients, it is even worse. At some point, medical practices may have to stop seeing Medicare patients altogether, and this is completely understandable. This is what Doctors mean when we say cuts such as this threaten access to healthcare for our Seniors.

And I am not alone in my criticisms of this proposal.

In a statement , Anders Gilberg, Senior Vice President for Government Affairs at Medical Group Management Association, said this:

CMS has again proposed a negative Medicare physician fee schedule update for 2025 with dangerous implications for beneficiary access to care. A 2.8% reduction to the conversion factor would be alarming in the best circumstances, but to propose doing so at a time when 92% of medical groups report increased operating costs and are otherwise struggling to remain financially viable is critically short-sighted. Medicare physician reimbursement is on a dire trajectory and these ongoing cuts continue to undermine the ability of medical practices to keep their doors open and function effectively — the need for comprehensive reform is paramount. MGMA is once again calling on Congress to pass the Strengthening Medicare for Patients and Providers Act to implement an annual inflation-based physician payment update tied to the Medicare Economic Index, and modernize Medicare’s antiquated budget neutrality policies by enacting the Provider Reimbursement Stability Act.

I could not agree more. The American College of Rheumatology also criticized the proposal in a press release :

"Physicians are currently grappling with rising overhead costs, workforce shortages, and increasing administrative burdens. Meanwhile, Medicare physician payments have declined by 29% from 2001 to 2024 , a trend not seen in other healthcare sectors where payments are adjusted annually for inflation," said Deborah Dyett Desir, MD, president of the American College of Rheumatology.

"While we appreciate the continued add-on payment for evaluation and management (E/M) visits, we are disappointed by the inadequate 2.80% change to the base rate. The ACR had hoped that CMS would propose Medicare reimbursement levels that more accurately reflect the cost of providing care."

So, clearly, it is not about "physician greed." That gaslights and obfuscates the issue. The issue, rather, is this: medical practices are facing steep inflation for everything, and the reimbursement from CMS - and other payers - simply does not keep up.

Major corporations have felt the sting of decreasing reimbursement and have responded by simply closing up shop. Cases in point: Walgreens and VillageMD and Walmart and its closing of Walmart Health . This is what we mean by threatening access to care.

It just baffles my mind that CMS would propose another pay cut.

There is a comment period for this proposal, and I encourage everyone to submit their comments to CMS online at https://www.regulations.gov . Follow the “Submit a comment” instructions.

I would also urge each and every one of you to contact your elected officials and tell them that this proposed cut is simply unacceptable, and that they MUST finally fix this flawed formula.

The cost of running a medical practice is so much higher today than it was even five years ago. Covid had a lot to do with this, and it is the reality of the practice of medicine today. Proposing yet another cut in reimbursement threatens the financial viability of medical practices large and small all across our country. It is the height of irresponsibility, and it leads me to end where I started:

WTF, CMS?

Listen to my podcast episode on this issue:

https://healthcaremusings.substack.com/p/wtf-cms