MedPAC Suggests No Medicare Payment Increase for Physicians

The Medicare Payment Advisory Commission (MedPAC) is recommending no fee-for-service Medicare payment update for physicians and other healthcare professionals in 2021, citing good access to care for beneficiaries.

“Overall, access to clinician services for Medicare beneficiaries appears stable and comparable with that for privately insured individuals,” the commission stated in its annual March report to Congress released on Friday. “Other measures of payment adequacy are stable and consistent with prior years. Therefore, the Commission does not see a reason to diverge from the current-law policy of no update for 2021.”

Physicians and other healthcare professionals treating Medicare patients can, however, still earn Medicare payment updates through the Quality Payment Program, a value-based reimbursement program introduced through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

While most beneficiaries reported being able to see a doctor when they needed to for both routine care and care related to an illness or injury, there were some access to care challenges, according to this year’s March report.

Consistent with prior reports, beneficiaries encountered more difficulties seeking a new primary care physician versus a new specialist, MedPAC reported. Specifically, among those looking, 85 percent of beneficiaries had no problem finding a specialist, while 72 percent of beneficiaries had no problem finding a primary care physician.

Minorities were also significantly more likely to face this and other access to care challenges, MedPAC found.

“Consistent with general trends in poorer access to health care among racial and ethnic minority groups, we continue to find through the Commission’s telephone survey that Medicare beneficiaries who belong to racial or ethnic minority groups are more likely to face difficulties finding a new physician and to wait longer than they want for care compared with White beneficiaries,” the commissions stated in the report.

The access to care problem for minorities was not unique to Medicare though. Minorities who were privately insured also reported access to care problems, the report stated.

The report also remarked upon the new mix of clinicians seeing Medicare patients. MedPAC found that the mix of clinicians has changed over, with the number of primary care physicians billing the fee schedule for at least 15 beneficiaries in a given year decreasing in 2017 and 2018. The decrease translated to 1,000 fewer primary care physicians billing Medicare in 2018 compared to 2013.

Meanwhile, the number of advanced practice registered nurses (APRNs) and physician assistants (PAs) billing Medicare increased rapidly. The number of these clinicians increased from 146,000 in 2013 to 237,000 in 2018.

The number of specialist physicians and other practitioners, including physical therapists and podiatrists, who billed Medicare also increased modestly.

Additionally, most clinicians (97 percent) who billed Medicare in 2018 were participating providers, MedPAC noted.

The findings indicate that fee-for-service Medicare payments “appear adequate,” the report stated.

While physicians are unlikely to see a payment update in 2021, MedPAC did offer suggestions for other providers, including hospitals and post-acute care organizations.

MedPAC recommended that Congress increase fee-for-service Medicare payments for hospital services by 2 percent in fiscal year 2021, using the difference between the update and amount specified in current law to increase hospital payments through its proposed Hospital Value Incentive Program.

The commission also recommended an update of 2 percent for long-term hospitals. Meanwhile, it also advised Congress to eliminate the updates for ambulatory surgical center services, skilled nursing facilities, and hospice services, as well as decreases for home health agencies (-7 percent) and inpatient rehabilitation facility services (-5 percent).

The commission did not recommend a fee-for-service Medicare payment update for the end-stage renal disease prospective payment system.