I really wanted to grab your attention with the title of this blog. No, this is not a debate about Medicare for all. This is a call to action and awareness because the proposed cuts to Medicare could mean a change in Medicare forever, and not for the better. You don’t see it on the news each day or people chatting about it on Reddit or Instagram, but the proposed Medicare cuts should be on everyone’s feed. Whether you’re patient or a provider, the Medicare cuts affect you, and not in a good way. You might be thinking, I’m not on Medicare so why should I care? Well, for one, I bet many of your loved ones are on Medicare, and one day you might be on it too. And if the past has taught us anything, if Medicare makes a policy change, then private/commercial insurance is likely to follow suit, especially if they think it’s saving them money.
If you haven’t been in the medical circuits, you might not even know what is going on. First, it’s helpful to understand how Medicare reimburses your physician/provider for a service. In the outpatient setting, there are two main types of services that your doctor provides, one that is what I call a “thinking service,” referred to as an Evaluation and Management (E&M). This would apply to an office visit to get an antibiotic for your sinus infection or an evaluation for your physical exam. The other type of service is a “doing service” where you might have a procedure, such as a Vitamin B12 shot or a skin biopsy. Often your doctor might do a thinking and doing service on the same day, what we call same day care. This is routine for dermatology where we might treat a teenager’s acne but also freeze their wart, or we might perform a skin check and then biopsy a potential melanoma.
The problem is that the proposed Medicare changes include a 50% cut to same-day care. So, if you were to have a skin exam and a biopsy, then Medicare would only pay for half of the office visit (E&M) done on the same day as a medically necessary procedure. Translation–providers won’t be able to continue to do both so you would likely have to choose between a “thinking” and “doing” service. Would you prefer your skin check or your biopsy today? Biopsy? Ok, then we will schedule you back for your skin exam. While this seems impractical, it is likely going to be the consequence of these proposed cuts. Think about how frustrating this might be—taking off work again or missing school or travel time and gas costs. Not to mention the fact in dermatology, access is already a challenge, and many patients wait months to be seen. If we now have to make additional appointments to perform the very services we used to do in one visit…Well, you can see the problem. Access to dermatology and other specialties is going to be even more difficult and delayed.
Now another aspect of the proposed cuts is also a big hit to dermatology practices. CMS proposed a new methodology to calculate practice expenses (PE), without physician input. PE cuts impact independent practices the most. They function on tight margins and have little recourse to absorb cuts to their administrative and infrastructure budgets. The result? Private practices will not be able to keep their doors open and many will be forced to close or consolidate—meaning joining a healthcare system or private equity group in order to survive. Not to be dramatic, but the proposed Medicare cuts could literally be the death of the independent, private physician practice.
If the Medicare cuts are such a bad idea, then why are they on the table? Well, CMS, the Center for Medicare and Medicaid Services, has proposed them to reduce healthcare costs. This is due to the budget neutrality law, which requires CMS to balance the Medicare budget. There is a fixed pie of money and it has to be redistributed in order to keep the budget balanced. The problem is Medicare cuts aren’t just numbers on a page—they can change who gets care, when they get it and whether they get it at all.
Trotter’s Take: Bottom line, the proposed Medicare cuts are a patient access issue, and we need to act now to stop them.
Want to learn more? Then check out my podcast with Dr. Sandy Marchese Johnson where we take the conversation beyond the headlines and break down what Medicare changes really mean for patients.
