The AMA is telling Congress not to cut Medicare payments to physicians. The AMA would be smart to speak up for patients and the problems their physicians have getting patients the care they need in Medicare Advantage. The Medicare Advantage plans are getting tens of billions in overpayments, money that could go to pay physicians higher rates.
The AMA has spoken directly against prior authorization policies, the policies that insurers use in Medicare Advantage and in the commercial market to delay and deny care. The policies are all different in each Medicare Advantage plan. And, CMS is hard-pressed to regulate them. But, one AMA survey finds that physicians say these policies are often not evidence-based and can result in premature death and disability, along with other patient harms.
Meanwhile, Medicare cut physician rates by 3.4 percent on January 1. Since the deadline for government funding is January 19, budget negotiations present an opportunity for Congress to reverse that cut.
Is the AMA whining about nothing really when it comes to Medicare rates? Will doctors continue to treat people with Medicare even given the Medicare rate cuts? It’s hard to say. The Medicare Payment Advisory Commission, MedPAC, supports raising physician rates in keeping with inflation.
MedPAC will report to Congress in March on whether Medicare physician rates are appropriate or should be changed. Jesse Ehrenfeld, the AMA President, claims that “if you look at physician payments over time adjusted for inflation, rates actually fell 26% from 2001 to 2023.”
Here’s more from Just Care:
- Need a shrink? Your Medicare Advantage plan might not think so
- AMA unhappy with Medicare payments, silent on health insurer interference in the practice of medicine
- How prior authorization requirements in Medicare Advantage could threaten your health
- Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts
- Rural hospitals accept Medicare Advantage at their peril
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