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Diving brief:

• Commissioners of the Medicare Payment Advisory Commission largely supported recommendations to increase the salaries of doctors and other health care professionals by an amount slightly below inflation and to establish additional payments for services provided to registered with low income.
• For 2026, the proposal would pay doctors and other clinicians caring for Medicare patients at the projected increase in the Medicare Economic Index minus one percentage point. That would increase their pay by 1.3%, and the additional safety net reimbursement would increase the average clinician’s fee schedule payments by another 1.7%, MedPAC staff members said at a meeting Thursday .
• But some commissioners indicated they would not support payment updates below inflation in the long term, arguing that it could hurt provider morale and beneficiaries’ access to quality care.

Dive overview:

Doctors have long pushed for increased Medicare reimbursement, saying their payments does not cover rising costsespecially with increased inflation.

MedPAC, which advises Congress on the Medicare program, had already considered linking their salaries to inflationpotentially providing physicians with more financial predictability and stability.

The commission also must balance government spending and access to health services for Medicare enrollees – who could suffer if reimbursement to providers is not enough to keep their doors open or continue accepting Medicare insurance.

Although access to care for Medicare patients is as good or better than those with private insurance, low-income beneficiaries face more difficulty accessing health services. Eleven percent of registered under the Medicare Part D low-income subsidy, reported having difficulty getting the health care they needed, compared with 7.5% of all other beneficiaries, one study found. MedPAC report.

The additional payments, which would be for the care of fee-for-service Medicare beneficiaries who are also enrolled in Medicaid or the Part D subsidy, are intended to improve care for these patients.

Under the proposal, first recommended by the commission in 2023, primary care clinicians caring for low-income enrollees would receive a 15% supplement to their fee schedule payment rates, while all other clinicians would receive a 5% raise.

Although commissioners largely expressed support for additional payments and increased reimbursements just below the MEI, some expressed concerns that a below-inflation wage increase could spark employment concerns. long-term access.

Over the years, this would mean less funding for the organizations where doctors work, but it would also send a negative message to clinicians at a time when they are already reporting increased burnout.

“The fee schedule is understood very personally by physicians as individuals, and no one likes to be told that their annual salary every year, indefinitely, year after year, will not keep up with inflation,” said curator Lawrence Casalino, professor emeritus. in Public Health at Weill Cornell Medical College. “Over time, I think this is likely to affect the morale of doctors and other clinicians, and that can only result in more difficult access and lower quality of care.”

And even though access to care among Medicare beneficiaries appears good compared to the privately insured population, patients still sometimes have to wait weeks before they can get an appointment, noted Commissioner Brian Miller, associate professor of medicine at Johns Hopkins University and nonresident scholar. at the American Enterprise Institute.

Sixteen percent of Medicare beneficiaries waited more than eight weeks for an appointment with a new specialist, according to the MedPAC report. That could pose a significant challenge for a patient facing a new cancer diagnosis or for a beneficiary who needs to follow up with an orthopedic surgeon after an injury, Miller added.

Long wait times are a problem, but it’s unclear whether payment rates could address market constraints that have become a problem for all patients needing health services, Commissioner Stacie Dusetzina said , professor of health policy and cancer research at Vanderbilt University Medical Center.

Additionally, the commission must keep in mind that increasing provider compensation would also increase cost sharing and premiums for beneficiaries, said Chairman Michael Chernew, professor of health policy and director of the Markets and Markets Lab. in health care regulation at Harvard Medical School.

“So when we pay more, we really need to think about what we’re getting in return,” he said. “And while I understand the desire of doctors and others to be paid more, we must also understand that in doing so, the cost is ultimately borne by beneficiaries, taxpayers and others. So it’s a balancing act.