Protecting Patient Access to Office-Based Specialty Care
Op-Ed: Protecting Access to Life-Sustaining Care Must Be Congressional Priority
By Mark Garcia, MD, is CMO for American Vascular Associates and the health policy advisor for United Specialists for Patient Access (USPA)
Our healthcare system, already burdened and fragile, is currently staring at a ticking time bomb in the form of ongoing Medicare reimbursement reductions to office-based providers. These CMS initiated cuts in the Medicare Physician Fee Schedule, already in motion, pose a significant threat to the well-being of patients and the overall stability of our health system. Further cuts to office-based specialists under Medicare continue to accelerate the health system consolidation trend, exacerbate health inequities in a variety of diseases, and threaten the pandemic resilience of our healthcare system.
Our elected leaders in Washington, D.C. must act now to safeguard the most vulnerable members of our society from losing access to life-sustaining care.
The recent introduction of H.R. 3674, the “Providing Relief and Stability for Medicare Patients Act of 2023,” is a much-needed lifeline for community-based physician practices and their patients because it will stop ongoing cuts to office-based specialists for the next two years. The bipartisan legislation addresses the pressing issue of insufficient Medicare physician payments and ensures the continuity of vital office-based specialty care. This will stop office-based specialists from going out of business and leaving their patients in the cold.
Office-based specialists play a crucial role in delivering a wide range of services to Medicare beneficiaries outside of the hospital setting. Patients with conditions such as cancer, end-stage renal disease, eye disease, fibroids, and limb salvage and venous ulcer needs heavily rely on these specialists for their care. Moreover, the office setting facilitates timely access to healthcare services, particularly for those living in rural and underserved areas. I know from working on the frontlines that this bill is a start to helping curtail the current health care consolidation trend and protect outpatient access to quality care across the United States. Patients have a strong preference for office-based providers and we know that the quality of care is as safe as in the hospital setting.
It is crucial to recognize the growing gap between the actual costs of running a physician practice and the reimbursement provided by Medicare. This discrepancy, coupled with the burdensome administrative and financial requirements of participating in Medicare, has led to market consolidation in the healthcare industry. Without intervention, the severity of ongoing payment cuts, combined with anticipated adjustments in the forthcoming CY2024 PFS, could push many physicians to a breaking point. This would result in providers leaving the field, practices closing or being sold, and patients losing access to diverse healthcare services in their communities.
The stability of office-based specialty care has been under threat due to the wild swings within the Medicare Physician Fee Schedule (PFS). Fiscal uncertainties, including statutory payment cuts, a lack of inflationary updates, administrative barriers, and the cumulative impact of the pandemic, have placed significant financial strain on community-based physician practices.
H.R. 3674 comes as a ray of hope for these practices by providing targeted relief for the challenges they face. By addressing the negative headwinds experienced in the 2022 PFS this bill ensures that these practices can continue to serve their patients effectively.
I urge Congress to act swiftly in passing this legislation in order to preserve the vital doctor-patient relationship that lies at the heart of our healthcare system.
Mark Garcia, MD, is CMO for American Vascular Associates and the health policy advisor for United Specialists for Patient Access (USPA).