Long-Term Impact of Indiscriminate Cuts to Medicare on Access to Services—Finding a Better Path Forward

When seniors get sick, they rely on care from their local doctors who they trust. Being seen close to home by a physician you have a strong relationship with is vital, especially for Missourians in the most rural parts of our state.

While skyrocketing healthcare costs must be reined in, Medicare cuts being pushed through in Washington threaten to destabilize community physicians and stretch hospitals even thinner during an incredibly precarious time. If hospitals and practices are forced to scale back services or even close down, who will our rural seniors be able to turn to? In order to ensure patients have access to care close to home, Missouri’s Members of Congress must stand up against these harmful cuts in favor of other reforms aimed at controlling costs while preserving access to value-based health care.

After going above and beyond during the pandemic, the professionals at the forefront of our healthcare system are facing three major challenges, all of which could disrupt Missourians’ access to care:

• skyrocketing inflation and labor costs that have led to persistently negative operating margins throughout 2022,

• a burnt-out labor force, a crippling nursing shortage, and a growing physician shortfall that is estimated to reach 100,000 doctors by 2030, and

• proposed cuts of 4.42% to all Medicare physician services, a statutory 4% Medicare payment reduction due to technical budget rules, and a 2% sequestration cut all set to go into effect in 2023.

At the same time, the net result of declining physician reimbursements and rising administrative burdens has been the exodus of physicians from private practice towards direct employment by hospitals or healthcare systems. An estimated 62% of physicians were independent in 2008; by 2021 that the number had dropped to 26%. In certain specialties such as cardiology, the change has been even more dramatic: in 2008 almost 90% of cardiologists were in private practice; by 2018 that number had dropped to 16%.

So what impact do these trends have on access to care for Missourians? In short, local communities may find it harder to access care close to home – and they will find their voices over regional healthcare delivery muted.

For the past decade, small rural hospitals across the state have been in distress, with the Missouri Hospital Association reporting the closing of 15 Rural/Acute Care Hospitals since 2014. As hospitals are forced to retreat into survival mode, smaller and medium sized hospitals (i.e., those in more rural areas) will inevitably shed non-profitable service lines. If unable to maintain financial viability, healthcare leaders will face the difficult decision to close down or sell to larger urban-based healthcare systems. Over time these consolidations and mergers may lead to the concentration of specialty services to large urban centers and away from those living in rural areas. Needless to say, driving several hours for care would be extremely inconvenient, and even impossible for some seniors who desperately need care. And because many practices and hospitals are major employers, the impact of these trends could reverberate throughout local economies.

This path is by no means set in stone, but it seems to be the default path based upon current trends and the fragile financial state of hospitals and healthcare systems across Missouri and the rest of the country if Congress does not take action.

The bipartisan Supporting Medicare Providers Act of 2022 (HR 8800)—introduced by Representatives Ami Bera, M.D. (D-CA) and Larry Bucshon, M.D. (R-IN)—both physicians themselves—would help address these challenges by forestalling the impending Medicare cuts. While it is not a silver bullet, the bill is a strong first step because preventing the cuts from coming into effect in 2023 would give Congress more time to craft a long-term solution. Moving forward, Congress ultimately must work with providers, patients, hospitals, and payors in partnership to develop reimbursement models that promote value, recognize the reality of budget constraints, reward high-quality and high-valued outcomes, align the incentives of payers, patients, and clinicians, and maintain access to care for all citizens.

If Missourians want to have a voice in creating a system that is equitable and inclusive of Missourians across the state regardless of geographic location or economic status, then Missouri’s elected officials should support HR 8800. Doing so would go a long way to ensuring the stability of our healthcare system and ultimately ensure patients’ access to the care they need close to home.

Dr. Soto is a graduate from the Washington University School of Medicine in St. Louis and has been practicing in Cape Girardeau, MO and surrounding communities as a specialist in Cardiovascular Disease and Clinical Cardiac Electrophysiology. The opinions expressed is this editorial are his own.