The Centers for Medicare and Medicaid Services (CMS) is proposing a significant rule change that would mean physicians receive half as much in reimbursement from Medicare for services provided on the same day as an office visit.
The American Medical Association and more than 150 healthcare organizations, including the Oklahoma State Medical Association, are calling for CMS to withdraw the proposal, arguing it could endanger patient health.
"We are talking about independent practices, rural physicians, who are bringing patients oftentimes with limited transportation and from long distances, to have several medical services performed at the same time," said Oklahoma State Medical Association President Dr. Julie Strebel. "Under this proposal, we would no longer be able to do that without an up to 50% decrease in our physician fee structure."
Strebel is a gynecologist and obstetrician with a private practice based in Oklahoma City. On a typical day in September, five of the 25 patients she treated use Medicare. The health insurance program serves people age 65 or older and some younger individuals with disabilities, and depends on federal support.
Strebel said her practice has never turned away patients for not having private insurance. Still, the proposed reimbursement rate reduction could change how she and other physicians treat Medicare patients.
Instead of addressing a patient's unanticipated health concerns in one appointment, the change incentivizes multiple visits to the doctor's office, she said.
"For example, in my gynecology practice, a Medicare patient comes in, and she reports that she's had some bleeding," she said. "Instead of just being able to take that patient in my office to the ultrasound room and do an ultrasound and do a biopsy, I have to send that patient potentially home, have her come back on a different day … Because if I do it all in one day, I won't actually get appropriate reimbursement for her visit."
She said she worries delaying patient care will mean more people go untreated.
"Anytime that a patient walks out of your office, you're not certain that they're going to come back," she said.
The federal government proposed a similar Medicare reimbursement reduction in 2019, but physicians and stakeholders rallied to stop the measure.
CMS said in a press release that the latest proposal will account for "overlap" between duplicative services and reflects "a broader Administration-wide strategy to create a healthcare system that results in better quality, efficiency, empowerment, and innovation for all Medicare beneficiaries."
Western Oklahoma podiatrist Dr. Brad Nelson said the insinuation that physicians are over-collecting for the healthcare services they provide Medicare patients is "insulting."
"I'm a Trump administration fan, but I don't think his administration as a whole has been really great in health care," he said. "...[Lawmakers] need to just get off their butts, talk across the aisle and fix things, as opposed to just cutting stuff left and right."
Nelson has been running a private podiatry practice in Oklahoma since 2004, and he said reimbursement rates for Medicare and Medicaid have decreased significantly over the last couple of decades – by at least 33% for his practice, he estimated.
Nelson said about half of his patients rely on Medicare, and many are from rural areas. His office is based in Clinton and has a satellite clinic in Elk City, drawing in patients from Altus, Hollis, Woodward and parts of Texas. The proposed reimbursement cuts would particularly impact rural patients who have to drive long distances to get care, or patients who rely on others to drive them to an appointment, Nelson said.
Nelson and Strebel both said healthcare decisions are often urgent, and shouldn't be dictated by a fee schedule. During a recent new patient visit, Nelson said he noticed a concerning spot and immediately conducted a biopsy. It came back as a Stage V melanoma.
"Can you imagine him getting delayed treatment because, you know, Medicare wanted to pay us a 50% reduction?" Nelson said.
He said the proposed reimbursement cut could force some physicians to stop serving Medicare clients completely. He said it has forced him to ask difficult questions about his own practice.
"Do I reframe my practice only to private insurance?" he said. "Do I cut employees?"
Strebel said rural hospitals could also be at greater risk of closure if a decreased reimbursement rate for Medicare is stacked on top of other recent cuts to federal healthcare plans.
"It's been proven, over and over, that when a rural hospital closes, the population that it serves becomes sicker," she said. "Not only that, we then are losing a vital business in that community … so the domino effect is huge with all of this. It's not just about cutting payment to a physician."
The proposed Medicare policy change is open for public comment until Sept. 14. If the change is approved, it will go into effect on or after Jan. 1, 2027.
This report was produced by the Oklahoma Public Media Exchange, a collaboration of public media organizations. Help support collaborative journalism by donating at the link at the top of this webpage.
