What Congress Should Do to Protect Medicare Providers


Since the start of the COVID-19 pandemic, SIMEDHealth and many other health care providers have worked tirelessly to provide care to our communities. Our SIMEDHealth team of 125 licensed healthcare providers in Florida and 514 employees impresses me daily with their dedication, ingenuity and endurance. We have resisted the battle against our relentless enemy physically, emotionally and financially. But now we face an additional reckless challenge, not from the virus, but from Congress.

Daniel M. Duncanson [ Provided ]

The impending reductions in health insurance costs will put more emphasis on health care in our region, as well as in others across the country. At this critical time, Congress must act very quickly to prevent these cuts from taking effect. All Medicare providers face reimbursement reductions of more than 10% from January 2022. For SIMEDHealth, this would have a significant impact.

Like other industries, the pandemic has already taken its toll on SIMEDHealth and other healthcare groups, as well as our patients. Like many employers, we are faced with a skilled labor shortage that is affecting our ability to largely provide services at the pre-pandemic level. We 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 to avoid this additional ordeal? Congress must take action, and do it quickly. All of these things will come into effect on January 1, unless Congress acts:

1. Since 2013, Congress has authorized an automatic 2% reduction in all Medicare payments. This Medicare sequestration was halted in April 2020 during the public health emergency, but it is expected to expire on December 31.

2. The Medicare Conversion Factor is a multiplier used by Medicare to calculate the reimbursement fee for each claim billed in Part B. The conversion factor is expected to be reduced by 3.75% in 2022.

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

We’re not the only ones worried about these potential cuts. A recent survey by the American Medical Group Association, the professional association representing multi-specialty medical groups and integrated healthcare systems like SIMEDHealth, found that the potential impact of the cuts includes hiring freezes, reducing staffing, the elimination of services and the refusal to accept new Medicare. the patients. Access to care and prompt responses to inquiries are two of the most common complaints health care providers hear from their patients.

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

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At SIMEDHealth, Medicare Advantage programs represent 40-50% of our Medicare patients. These possible Medicare Advantage reductions would be in addition to the 9.75% reductions above for traditional Medicare. All of these cuts to medicare create a potentially immediate untenable situation for the entire health care delivery system in the United States. At SIMEDHealth, these reductions will threaten our ability to continue our drive towards excellence for our patients and communities.

Now is never a good time to slash revenues by 10%, but doing so as SIMEDHealth and other healthcare groups continue to fight the effects of COVID-19 and variant strains is a slap in the face of Congress . To support our continued ability to provide care to our patients and our communities, we have a simple request from Congress. Stop these cuts before they take effect. It will take years for the effects of the pandemic 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 Managing Director of SIMEDHealth (Southeastern Integrated Medical Health), a group of multi-specialty physicians serving patients in North Central Florida.


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