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Guest Column
What Congress should do to protect Medicare providers | Column
If Medicare providers aren’t protected, care of Medicare patients could suffer as well.
University of the Pacific medical staff and a Medicare professional review data during a health clinic at Sierra Vista Housing Authority in Stockton, Calif.
University of the Pacific medical staff and a Medicare professional review data during a health clinic at Sierra Vista Housing Authority in Stockton, Calif.
Published Nov. 23

Since the start of the COVID-19 pandemic, SIMEDHealth and many other health care providers have worked tirelessly to provide care for our communities. Our SIMEDHealth team of 125 Florida licensed health care providers and 514 employees impress me daily with their dedication, ingenuity and sheer stamina. We’ve physically, emotionally and financially weathered the battle on our unrelenting foe. But now, we’re facing an additional heedless challenge, not from the virus, but from Congress.

Daniel M. Duncanson
Daniel M. Duncanson [ Provided ]

Looming Medicare fee cuts will further stress health care in our region, as well as in others across the nation. At this critical time Congress needs to act very soon to prevent these cuts from taking effect. All Medicare providers are facing upwards of 10 percent cuts in reimbursements starting in January 2022. For SIMEDHealth this would have a significant impact.

Similar to other industries, the pandemic already has inflected a toll on SIMEDHealth and other health care groups, and our patients. Like many employers, we face a shortage of qualified labor which affects are ability to broadly offer services at the pre-pandemic level. We have incurred the increased costs associated with continuing to protect our staff and patients. These potential Medicare cuts would further exacerbate the financial pressures facing all health care providers.

How can this added hardship be prevented? Congress has to take action, and do it soon. All of these things will go into place Jan. 1, unless Congress acts:

1. Since 2013 Congress has authorized the automatic reduction of all Medicare payments by 2 percent. This Medicare sequestration was halted in April 2020 during the public health emergency, however it is slated to expire Dec. 31.

2. The Medicare conversion factor is a multiplier used for Medicare to calculate the reimbursement fee for each and every Part B billed claim. The conversion factor is scheduled to be reduced by 3.75 percent in 2022.

3. The Pay-As-You-Go Act of 2010 (PAYGO) requires all new legislative expenditures, taxes, or fees taken together must not increase projected deficits. As a consequence of the pandemic related relief spending since March 2020, automatic 4 percent reductions in the fee schedule will occur.

We are not alone in our concern about these potential cuts. A recent survey by the American Medical Group Association, the trade association representing multi-specialty medical groups and integrated health care systems like SIMEDHealth, found the potential impact of the cuts include hiring freezes, reduction in staff, elimination of services and not accepting new Medicare patients. Access to care, and timely responses to inquiries are two of the common complaints health care providers hear from their patients.

Medicare beneficiaries in various areas of our region and across the country are already significantly limited in their access to reliable health care. How will shrinking reimbursements for those who are trying to provide improved access, services and responsiveness incentivize them to continue to do so? To add further financial stress, some in Congress are considering additional cuts to the Medicare Advantage (MA) program, an increasingly popular choice of Medicare beneficiaries.

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At SIMEDHealth Medicare Advantage programs account for 40 percent to 50 percent of our Medicare patients. These possible Medicare Advantage cuts would be in addition to the above 9.75 percent reductions to traditional Medicare. All of these Medicare cuts create a potential immediate untenable situation for the entire U.S. health care delivery system. At SIMEDHealth, these cuts will threaten our ability to continue our push towards excellence for our patients and our communities.

It’s never a good time to have revenue cut by 10 percent, but to do so when SIMEDHealth and other health care groups continue to fight through the effects of COVID-19 and variant strains is a Congressional slap in our faces. To support our continued ability to provide care to our patients and communities, we have a simple request of Congress. Stop these cuts before they go into effect. It will take years for the pandemic related effects on employers and health care organizations to recover. We need financial stability, not cuts, to survive in the present.

Dr. Daniel M. Duncanson is the chief executive officer of SIMEDHealth (Southeastern Integrated Medical Health), a multi-specialty physician group serving patients throughout North Central Florida.