VOICES: Cuts to 2022 Medicare reimbursements hurt Dayton doctors

Mr. Juan Fraiz is the Chief Executive Officer of PriMED Physicians.
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Mr. Juan Fraiz is the Chief Executive Officer of PriMED Physicians.

Since the start of the COVID-19 pandemic, PriMED Physicians has worked tirelessly to provide care for our community and our 65,000 Dayton-area patients. Our team of 44 physicians and 232 employees impress me daily with their dedication, ingenuity, and sheer stamina. Like other healthcare delivery organizations, we’ve battled an unrelenting foe — physically, emotionally, and even financially. But now we’re facing an additional and heedless challenge, not from the virus but from the US Congress.

Looming cuts in Medicare will cause our medical group, as well as other medical groups and health systems across the nation, further significant stress at this critical time and may disrupt healthcare providers’ ability to continue to deliver care to the communities they serve. This comes at a time when “The Great Resignation” wave is negatively impacting most U.S. businesses, as well as the impact of financial price inflation and supply chain difficulties continue to increase organizations’ operating expenses and forcing them to increase consumer prices. Unlike other businesses, healthcare organizations cannot pass along increases to consumers through price increases because of their contractual arrangements with health plans & government payors. PriMED Physicians provides healthcare services to over 8,000 Medicare and Medicare Advantage (“MA”) patients in the greater Dayton area that account for approximately 39% of its patient volumes. Congress needs to act to prevent these cuts from taking effect.

Providers are facings upwards of 10% cuts in Medicare starting in January 2022. For PriMED Physicians, this would have a significant impact. The pandemic already has inflicted a toll on our organization and patients. These potential cuts would exacerbate the financial pressure facing us and all providers. What needs to happen to prevent this hardship? Congress should delay the pending 2% Medicare sequester and eliminate the 4% Medicare Pay-As-You-Go cut. Congress also should cancel a scheduled 3.75% decrease in the Medicare conversion factor.

We are not alone in our concern about these potential cuts. A recent survey of medical groups like ours, conducted by AMGA, the trade association representing medical groups and integrated systems, found that the potential impacts of the cuts include hiring freezes and reductions in staff, elimination of services, and possibly not being able to accept new Medicare or MA beneficiaries.

To add further financial stress, Congress may consider cuts to the MA program, an increasingly popular choice of Medicare beneficiaries. At PriMED Physicians, MA patients accounts for 56 percent of our total Medicare patients visits. These possible cuts to MA are in addition to the possible 10% cuts to traditional Medicare. This creates an untenable situation not only for PriMED Physicians, but for the entire healthcare delivery system. These cuts threaten our ability to do our absolute best for our patients and community. Should Congress implement these cuts, we would need to seriously consider numerous changes, some of them like what our peers voiced in the AMGA survey. Clearly, these cuts could not come at a worse possible time, especially as we see the impact of new coronavirus variants, such as the Delta variant we are now battling.

To support our continued ability to fight against COVID-19 and provide care to our patients and community, PriMED Physicians has a simple request of Congress. Stop these cuts before they go into effect on January 1, 2022. The pandemic is ongoing, and it may take years for our healthcare system and our communities to fully recover. Healthcare organizations continue to experience untold strain, and we need financial stability, not cuts, to survive in the present operating environment and be able to deliver the highest quality of care to all Medicare beneficiaries.

Mr. Juan Fraiz is the Chief Executive Officer of PriMED Physicians.

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