Thread by @MarilynHeineMD

🧵AMA to #Congress:

•Do not extend 2% #Medicare sequester as a spending offset in soon-to-be considered #infrastructure package.

•Do not divert scarce health-related offsets to meet objectives unrelated to healthcare.

Physicians already face steep Medicare fiscal challenges.

2/ AMA expresses “deepening alarm concerning the growing financial instability of the Medicare physician payment system.”

“Not only does Congress seem indifferent to the confluence of fiscal uncertainties confronting physician practices at the end of this year, but…”

3/ “…lawmakers’ pursuit of policies to extend the current Medicare sequester that, in effect, will require physicians and health systems to pay for
hard infrastructure amplifies our ongoing concerns.”

4/ On 1/1/22, physician practices face this stack of Medicare financial hits:

👉 1. Expiration of the current reprieve from repeatedly extended 2% sequester stemming from BCA of 2011. Congress originally scheduled this policy to sunset in 2021 but it will now continue into 2030.

5/ More Medicare hits to physician practices:

👉 2. Imposition of a 4% Statutory PAYGO sequester resulting from passage of ARPA, presumably for at least another 10 years. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO.

6/ More Medicare hits to physician practices:

👉 3. Expiration of the Congressionally enacted 3.75% temporary increase in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustments tied to PFS policy changes.

7/ • A statutory freeze in annual Medicare PFS updates under MACRA that is scheduled to last until 2026, when updates resume at a rate of 0.25% a year indefinitely, a figure well below the rate of medical or consumer price index inflation.

8/ 🔥Combined, physician practices face a 9.75% cut on January 1.

🔥Additionally, potential penalties under MIPS, which apply to Medicare PFS services, will increase to 9% in 2022.

9/ “All this financial uncertainty comes at a time when physician practices are still recovering from the financial impact of the COVID-19 public health emergency, including continued infection control protocols that, while necessary, have increased the costs of providing care.”

10/ “The combination of all these policies would be challenging to endure in normal times. Yet, physician practices
continue to be stretched to their limits clinically, emotionally, and financially as the pandemic persists well beyond 15 months.”

11/ 👉 ”The enactment of further Medicare payment cuts will undoubtedly threaten
patient access to care, especially considering the stark reality that, adjusted for inflation in practice costs…”

🔥 Medicare physician payment actually ⬇️ 22% 2001 to 2020, or average 1.3%/year.

12/ “The AMA continues to respectfully request Congress to convene hearings on the alarming state of the Medicare physician payment system, not only from a financial perspective but also related to many fundamental operational aspects.”

13/ “The promise of a robust & patient-centered alternative payment model pathway for physicians under MACRA has yet to be realized…”

14/ “…leaving the majority of practices stuck in the MIPS portion of the MACRA program, with legacy and siloed cost and quality measurement programs that impose steep administrative burdens while lacking clinical relevance.”

15/ “We cannot achieve the promise of high-quality, coordinated care that helps patients achieve optimal health if the barriers to success in the MACRA program are not examined and addressed.”

16/ 👉 “The state of the [MACRA] program is increasingly dysfunctional and, ultimately, it will be patients who suffer.”

17/ “In the interim, the AMA strongly urges #Congress not to divert increasingly scarce health care dollars for non-health care purposes, especially when there are so many uncertainties and current policies are already
undermining the Medicare physician payment system.”

18/ @AmerMedicalAssn letter to @SpeakerPelosi @GOPLeader @LeaderMcConnell @SenSchumer: tinyurl.com/83kbwbj4

#Congress must not divert increasingly scarce healthcare $ for non-healthcare purposes, esp. w/so much uncertainty & policies that undermine Medicare physician payment.

19/ Take a look at the gap chart‼️

After adjusting for inflation in practice costs, Medicare physician pay declined 22 percent from 2001 to 2020, or by 1.3 percent per year on average.

tinyurl.com/83kbwbj4

20/ • Medicare physician pay has barely changed for nearly two decades, increasing just 7 percent from 2001 to 2020, or just 0.3 percent per year on average. 
·       The cost of running a medical practice increased 37 percent between 2001 and 2020, or 1.7 percent per year.

21/ In comparison:

·       Medicare skilled nursing facility and inpatient and outpatient hospital updates totaled around 60 percent between 2001 and 2020. These are equivalent to average annual increases of 2.4-2.5 percent per year.