LUGPA Policy Brief: Medicare Patient Access and Practice Stabilization Act

November 4, 2024

Independent medical practices are at a breaking point. Physicians and their staff face an array of pressures that make delivering patient care increasingly difficult. Rising operating costs, widespread burnout, heavy administrative burdens, staffing shortages, and constantly shifting regulations add significant strain.

Reduced Medicare reimbursement further limits healthcare access, worsening physician burnout and jeopardizing care for Medicare beneficiaries amid a nationwide physician shortage. CMS’s required cuts stem from statutory restrictions, compounded by Congress’s ongoing inaction.

Since 2001, Medicare physician payments have dropped by 29% when adjusted for inflation, while healthcare expenses have surged. With CMS’s proposed 2.8% reimbursement cut for 2025 and a forecasted 3.6% increase in practice costs, practices will face an effective 6.4% reduction.

New Legislation to Stabilize Medicare Payments

In an effort to address this growing issue, a bipartisan group in the U.S. House of Representatives, led by Rep. Greg Murphy, MD (R-NC), has introduced the Medicare Patient Access and Practice Stabilization Act. This vital bill aims to counter the 2.8% cut to the Medicare Physician Fee Schedule (PFS) conversion factor set for 2025. Without this intervention, the reduction and rising expenses threaten the financial viability of independent practices nationwide, particularly in underserved areas.

Key Provisions of the Medicare Patient Access and Practice Stabilization Act

1. Reversing Conversion Factor Cuts: This bill proposes a 4.73% increase in the PFS conversion factor, reversing the impending 2.8% reduction and adding a 1.9% inflationary adjustment for 2025. This increase represents roughly half of the Medicare Economic Index, acknowledging the rising cost of healthcare delivery.
2. Inflationary Updates for Physicians: The legislation provides physicians with an essential inflationary update, addressing long-overdue rising operational costs and creating a more sustainable Medicare payment model.

Stable Medicare reimbursement is essential for LUGPA members to deliver high-quality, accessible urological care. Practices nationwide face severe financial pressures, threatening critical services for Medicare patients. This bill aligns with LUGPA’s advocacy for fair, inflation-adjusted Medicare payments that allow physicians to focus on patient care, not just financial survival.

The Medicare Patient Access and Practice Stabilization Act represents a vital move toward ensuring the sustainability of physician practices, particularly independent specialty practices like urology. By prioritizing patient access and equitable Medicare payment updates, this legislation offers a path to financial stability for practices dedicated to caring for the country’s aging population. LUGPA strongly supports this bill and encourages members to advocate for lawmakers' efforts to champion these reforms.