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A majority of House members urged House leaders to not only reverse a proposed 2.8% cut in the Medicare Physician Fee Schedule (MPFS), but also to pass a law that would avoid such cuts in the future.

"Increased instability in the healthcare sector due to looming cost hikes impacts the ability of physicians and clinicians to provide the highest quality of care and threatens patient access to affordable healthcare," read a signed by 233 House members and spearheaded by Reps. Mariannette Miller-Meeks, MD (R-Iowa) and Jimmy Panetta (D-Calif.). "In lieu of these harmful cuts, which, absent federal legislation, will take effect on January 1, 2025, Congress must pass a bill providing physicians and other clinicians with a payment update that takes into account the cost of actually delivering care to patients." The letter, which was dated October 11 and made public on Tuesday, was sent to House Speaker Mike Johnson (R-La.) and House Minority Leader Hakeem Jeffries (D-N.Y.).

The letter noted that the proposed cuts mark the fifth consecutive year that CMS has proposed a cut to the fee schedule. "While Congress has stepped in the past 4 years to pass legislation to mitigate portions of these cuts, the fact remains that the MPFS is inherently broken," the members wrote. "The continued cuts have forced medical groups and integrated systems of care to make difficult choices, such as imposing hiring freezes, delaying system improvements, delaying implementation of care model changes including transitions to value-based care systems, and possibly eliminating services."

Medicare payments have fallen by 29% over the last 2 decades when adjusting for the costs of running a practice, the authors pointed out. "In addition, compliance with the Merit-based Incentive Payment System (MIPS) is expensive and a flawed, insufficient way to measure quality and costs of care that has resulted in steep and unfair penalties."

In addition to the inflationary increase, "we also request that you enact targeted reforms to statutory MPFS budget neutrality requirements, raise the current MPFS budget neutrality threshold to be reflective of 2024 dollars ... mandate CMS review key elements of practice expense costs concurrently and no less often than every 5 years, and limit changes to the MPFS conversion factor to no more than 2.5 percent in a given year," the letter said. "We stand ready to work with you to pass crucial bipartisan legislative initiatives before the conclusion of the 118th Congress."

Physician groups praised the letter. "The Medicare payment system is fundamentally flawed, and repeated annual cuts are taking a significant toll on rheumatologists, rheumatology care teams, and the U.S. healthcare system as a whole," Deborah Dyett Desir, MD, president of the American College of Rheumatology, said in a statement. "We urge congressional leadership to heed the concerns of their colleagues and take action to implement meaningful legislative solutions that address payment cuts, reduce administrative burdens, and account for the impact of inflation on physicians. The time for change is now -- enough is enough."

The American Medical Association (AMA) also applauded the letter. "Unlike past congressional efforts, this letter also requests a payment update to reflect inflationary pressures on physician practices," said AMA president Bruce Scott, MD, in a statement. "As the letter says, the Medicare physician payment system is 'inherently broken.' Indeed, Medicare payment rates have over the past two decades, when adjusting for the costs of running a practice, threatening patient access and practice viability. "

"We have an upcoming election and only a short time to act," Scott said. "But the good news is that instead of gridlock, we have agreement. Instead of conflict, we have compromise. Let's get to work and pass these crucial policy changes before the end of the year."

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