The unofficial Doctors Caucus in the US House of Representatives thinks the time is right to overhaul Medicare payments to physicians, which could lead to a boost in provider pay. 

The group is composed of eight, bipartisan lawmakers with medical backgrounds — and five of them sit on the key Energy and Commerce and Ways and Means committee, both of which would play vital roles in ushering through any payment and entitlement program changes. Each year, congressional budget fights erupt over how to preserve Medicare and Medicaid funding despite rules recently put into place to slow federal spending.  

While there are statutory cuts enshrined in current law, legislation to delay or decrease the amount slashed is regularly introduced at the behest of physician groups, who refer to shortages among Medicare doctors who work in rural and underserved areas. 

“I think there will be significant efforts to come up with a permanent solution,” Cynthia K. Morton, executive vice president of Advion (pictured), told McKnights. “Whether these will be fruitful is hard to gauge right now because it’s so early in the year.”

A longtime complaint of the Physician Fee Schedule — as well as other entitlement program pay rates — is that it doesn’t keep pace with inflation, even outside of the wild ride the economy has been on lately. Morton said many stakeholders want to see the budget neutrality adjuster eliminated. That is the mechanism that forces reductions in CPT codes to offset increases in other codes. 

“A specialty won’t know from one year to the next as to what the reductions are going to be because CMS decided to increase another specialty’s codes,” Morton said. “Some years, especially the last couple, [there] have been significant offsets, and this is causing a world of pain for providers who are on the losing end of those offsets.”

Since taking control of the US House, Republicans have been talking up their plans to make significant cuts to federal spending, particularly in mandatory spending such as the entitlement programs. House Speaker Kevin McCarthy (R-CA) has said that Medicare and Social Security will be protected, but he has been quiet on whether that protection will extend to Medicaid.

 In fiscal year 2022, Medicare represented approximately 12% of all federal spending, according to the US Treasury. 

Still, mandatory spending is the “main driver of the national debt” and “everything’s on the table,” said prominent conservative Rep. Barry Loudermilk (R-GA), according to Axios. 

The informal Doctors Caucus, which is a different entity from the GOP Doctors Caucus, knows it has its work cut out to convince colleagues on both sides of the aisle to find a solution that does not imperil programs. 

“Every year we’re going to have to find a way to stave off these statutory cuts,” Rep. Larry Bucshon (R-IN) told Bloomberg Law. “Nobody on either side of the aisle thinks this is a good idea.”

But, he added, “We’re at a point where the reimbursement issues are hampering access to quality medical care.”