Drastic cuts proposed to Medicare would hurt health care quality

The drastic cuts Medicare has proposed to payment rates for hospital-based providers in 2021 have my blood boiling and should make anyone who believes in access to high-quality health care feel the same. 

It’s caught the attention of lawmakers. In fact, just last month, a letter signed by more than 220 bipartisan members of Congress was sent to Speaker of the House Nancy Pelosi (D-Calif.) and House Minority Leader Kevin McCarthy (R-Calif.), pleading for action before the end of the year to protect a health care system already stressed by COVID-19 and to ensure patient access to care.  

So what’s the issue? Each year, the rate Medicare pays for some services can change. By 2021, some services and some physicians will receive payment increases. Unfortunately, due to a longstanding problem in Medicare law, when some services and physicians get payment increases, others must receive offsetting payment decreases — a hunger games scenario. This is bad news for physician anesthesiologists.

Their payments for high-risk services provided on the front lines during the pandemic will be cut an unprecedented 10 percent. Medicare payment rates have not kept up with inflation for years, which makes the cuts hurt even more, especially for physician anesthesiologists. Their Medicare payment rates will be reduced to virtually the same level as Medicare was paying in 1991 — 30 years ago. Does any other government contractor get paid at 1991 rates?

Why is this a problem?

At the start of the COVID-19 public health crisis, nearly all surgeries were put on hold. This included so-called elective procedures and surgeries like rotator cuff repairs, cataracts and even heart surgery. As these surgeries were postponed for months, physician anesthesiologists hung up their surgical caps and grabbed their face shields and N95 respirators when they were called to critical care units to fight COVID-19. We stepped forward to take care of the most critically ill patients — many were likely Medicare beneficiaries — placing them on ventilators and making every effort to save their lives while risking our own by getting face-to-face with these patients.

One of the more common procedures physician anesthesiologists perform are intubations — placing the breathing tubes that keep patients alive during surgery and in the critical care unit. The procedure needed to place a patient on a ventilator is also one of the most dangerous during the pandemic. Each time a tube is placed or removed, millions of tiny particles of the highly infectious COVID-19 virus are expelled into the air exposing physician anesthesiologists and others nearby to infection. 

The “thank you” for risking our lives to save our patients? A flawed Medicare formula that cuts our payments through no fault of our own. 

With this proposed decrease in payment rates, hospitals with a higher Medicare-payer mix will have to figure out a way to cut corners, potentially with decreased staffing which we believe will affect the quality of care to seniors in the U.S. 

Those who will pay the ultimate price are our older patients, the uninsured or underinsured and other vulnerable populations who already struggle with access to quality health care. Medicare itself admits that its pay rate cuts are creating a two-tier health system, where patients without private insurance receive sub-par care. 

It is already difficult for physicians who work in hospitals with high volumes of Medicare patients to have the right staffing and resources to take care of patients. With lower government payer rates, you have fewer physicians, and it becomes even more challenging to provide quality care operating under these adverse conditions. There’s no doubt that this will contribute to disparities in health equity. 

We can’t allow this to happen. We need to ensure quality care for all, especially our seniors and other vulnerable populations. Urge Congress to eliminate the requirement to offset payment increases with cuts and remove this threat to physician anesthesiologists’ practices at a time when their expertise and critical care skills have never been more important.

Beverly K. Philip, M.D., is president of the American Society of Anesthesiologists. She is also the founding director of the Day Surgery Unit at Brigham and Women’s Hospital and professor of anesthesia at Harvard Medical School in Boston.