Provider Reimbursement Stability Act of 2023

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, in 1965, a program called Medicare was incepted. It was offering health benefits to those over age 65.

At first, physicians were very suspicious of allowing so much government intervention in medicine. After a while, more and more physicians doing their duty to take care of patients accepted it.

The sad fact and the problem is that Medicare now is what they, in 1965, were very afraid of, that so much of government has gotten into medical issues.

This is the main problem. Medicare does not reimburse the cost of care for patients. This is a real access issue. We are not really talking about paying physicians. We are talking about access to care.

This year, CMS is proposing a 3.37 percent cut to the physician fee schedule. It would be about a 20 percent cut over the last 20 years.

Doctors want to see Medicare patients, but they simply won't be able to, and this is going to affect access to care.

Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. Joyce), my good friend who is board-certified in internal medicine and dermatology.

Mr. Speaker, I yield to the gentleman from Texas (Mr. Burgess), one of the doctor co-chairs. He has been a stalwart in the Chamber for 20-plus years as a physician, a retired OB-GYN.

Mr. Speaker, it is about access. Physicians want to see Medicare patients, but if you do not pay the bills, they can't keep the doors open.

Mr. Speaker, I yield to the gentleman from Ohio (Mr. Wenstrup), my good friend and a board-certified podiatric surgeon.

Mr. Speaker, we are experiencing a doctor shortage, and it is going to get worse and worse, driving physicians out because they no longer are able to be paid for their services or forcing them into employment that destroys the historically great quality of medicine in America.

Mr. Speaker, I yield to the gentleman from California (Mr. Panetta), my good friend from the Ways and Means Committee.

Mr. Speaker, as you can see, this is obviously a bipartisan issue. We care about our constituents, but we also care about the health of our constituents.

Mr. Speaker, 10,000 Americans each day are added to the Medicare rolls. Again, with such a doctor shortage, you are adding more and more individuals where Medicare doesn't pay their bills, and it is harder and harder to take care of them.

Mr. Speaker, I yield to the gentleman from California (Mr. Bera), another physician friend of mine from the great State of California, to discuss the difficult problem we are facing today.

Mr. Speaker, the gentleman points out a perfect issue. We are depriving access to patients and developing more and more concierge medicine, which is wonderful for those who can afford it, but for those who can't afford to go and see one of these cash doctors, and you can't get into a doctor's office because they can't take more Medicare patients, guess what happens? They get driven to emergency departments where a more costly care goes on.

We have to stop this nonsense.

Mr. Speaker, I yield to the gentlewoman from Washington (Ms. Schrier), a pediatrician.

Mr. Speaker, if you owned a hardware store and sold hammers that cost $1 apiece but you had to sell them for 40 cents apiece, how long would you sell hammers?

You wouldn't sell them very long because it just doesn't make financial sense, and you literally can't just give money and walk money out the door.

Unfortunately, this is what is happening with Medicare patients. Physicians want to take care of their patients. They are caring individuals, but when the numbers don't matter, you just can't do it.

Mr. Speaker, I yield to the gentleman from Georgia (Mr. McCormick), and emergency room physician, to talk on this issue.

Mr. Speaker, may I inquire how much time I have remaining?

Mr. Speaker, I have seen Medicare patients for more than 30 years. I have had individuals come in my office after I have operated on and cared for them in the hospital and apologized, flat out apologized for the lack of payment that we received from Medicare.

I tell them I do it because I love operating and taking care of people, but there comes a point where you have to keep the lights on, you have to pay your nurses, and pay your mortgage.

Mr. Speaker, I yield to the gentlewoman from Tennessee (Mrs. Harshbarger), a doctor of pharmacy, to talk about the ridiculous cuts that are facing our colleagues as physicians.

Mr. Speaker, we submitted a bill, H.R. 6683, a couple weeks ago, and while ENC was able to keep the cut at 1.25 percent, we are actually desiring to not allow the cut at all. We are taking money from the Medicare Improvement Fund, which is what the money is for, to solve problems within Medicare.

Unfortunately, as this was a wonderful bipartisan discussion this evening, we are oftentimes imprisoned, if you will, sometimes to the will of some of the leaders over in Senate, sometimes even here in the House.

Leaders over in the Senate didn't want anything for a doctor fix. The Democratic leader said, no, we want this huge wish list of things done, and we will trade that for the doctor fix.

Well, guys, you can't take poison pills to try to help physicians. This is where there should not be politics whatsoever. We saw both sides tonight, Democrats and Republicans, speak about the healthcare of patients in this country.

Mr. Speaker, at some point it is going to snap. At some point, whether it be what Obamacare was trying to do, absolutely starve private practice so that everybody would either be bought out by private equity or have to be assumed by hospital systems. Where, by the way, physicians don't work as efficiently, physicians cost more, and they see fewer patients. It is a closer ownership care of patients.

When I was practicing full-time, if another doctor called me and said, hey, can you see somebody? My response was always: Do you want me to see them today or tomorrow?

The sad fact is once physicians become employed, not only do they cost more to the system, but the work ethic is not as good. That is just point-blank what is seen.

What we need to understand is that private practice is the most efficient way of delivering healthcare in this country, but it is also the one where we care the most, and we follow up. We are always happy to see that next patient and make sure that we keep our doors open.

At this point, Mr. Speaker, we are going to approach a calamitous cliff, if you will, in the next 3 to 5 years with the number of surgeons that are available to take care of patients.

I am a urologist. I take care of disorders of the kidney, prostate, and bladder--those type of things. We are the most critically short specialty in the country.

Right now, the median age of individuals practicing urology is my age, the age of 60. If now we are not paying doctors enough to stay in business, they are going to quit. We are going to make a bad shortage even worse. We have to pay those who take care of patients what they need to be paid.

Mr. Speaker, I appreciate that this was a bipartisan discussion this evening, something that is easy for our leadership to fix. I ask that they do that.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I rise today to talk about a very pressing issue that not only have we heard about throughout our country but especially in the 19th Congressional District of California, which I represent. It is the decreasing amount of reimbursement rates to Medicare providers. It is an issue, unfortunately, that threatens the care for many senior citizens that I represent.

Now, as the proud Representative of California-19, it is a place where the cost of living, unfortunately, can be pretty high--not just for families, not just for workers, but for doctors, as well.

We in the 19th are already facing challenges when it comes to keeping enough medical providers around to care for our seniors. It is actually a problem throughout California where not only is the cost of living too high, but also Medicare reimbursements are way too low.

Mr. Speaker, 76 percent of California physicians report that Medicare no longer covers their cost to provide care. That puts more than 6.5 million Californians enrolled in Medicare at risk as many primary care doctors are not even taking new part B patients.

A key driver of this is how Medicare isn't reimbursing physicians enough. This past year, Medicare expenses rose 4.6 percent. In the past two decades, payments to providers have declined 26 percent while costs to providers have risen 47 percent, according to the AMA.

What is worse is that when CMS updates payment rates for billing codes under part B, that creates many unsustainable cuts for too many providers and leads to way too many scheduled decreases to Medicare physician reimbursement.

Because of that, we are seeing physicians take on fewer Medicare patients, and we all know what that means--that there are more seniors with fewer healthcare options.

Now, fortunately, thanks to the leadership of Mr. Murphy and other Members of Congress who have come together in a bipartisan fashion for a temporary fix, this legislation would provide an offset for the cuts to providers so that our providers keep getting reimbursed appropriately, so that we can keep providers in our communities, and so that providers can keep serving the needs of seniors.

I am proud to work with Representative Murphy on the Ways and Means Committee for this straightforward fix to this problem, but this Congress needs to act with urgency, as these cuts have already taken effect.

Ultimately, we need a long-term solution to this issue by ensuring that Medicare reimbursement is keeping up with inflation and that the system is streamlined so physicians can continue to care for their patients.

We can't underestimate how Medicare plays an essential role in the health of senior citizens. That is why Congress must ensure that in order for it to continue to be that cornerstone of healthcare, we must provide our providers with the proper reimbursement so that our seniors can get proper healthcare.

I appreciate Mr. Murphy's leadership on this, and I look forward to working with many of our colleagues on both sides of the aisle to do our job by making sure the Federal Government works for our constituents by ensuring that Medicare always allows our providers to care for our senior citizens.

Mr. Speaker, I thank Mr. Murphy for bringing us together tonight. I am here tonight not just because I am a Member of Congress from the 26th Congressional District, but I am also a doc. I practiced for 25 years back home. I am a Medicare patient. I know firsthand how hard it can be to find a doctor that still accepts Medicare.

I will tell you, there is nothing more injurious to our medical system here in this country than the repetitive cuts that this administration has delivered to the doctors of this country.

In November, the Centers for Medicare and Medicaid Services finalized a 3.5 percent cut in physician payments for this year, 2024, a decision that took place on January 1 of this year, a blow to the very backbone of our healthcare.

As a member of the Energy and Commerce Committee, we had an actual historic event last month. We marked up a doc fix and a budget neutrality bill.

The GOP Doctors Caucus and the Energy and Commerce Committee took action to address the challenges by passing H.R. 6545, which was the Physician Fee Schedule Update and Improvements Act. That bill includes a conversion factor update as well as provisions

from H.R. 6371, the Provider Reimbursement Stability Act, also led by the GOP Doctors Caucus.

These provisions make needed changes to the budget neutrality requirement, allowing for long-term sustainability within the physician fee schedule. These are significant steps, and the urgency cannot be overstated.

On January 1, those lower rates went into effect. CMS has said they are going to hold payments until Congress acts, but if we don't act pretty darn quick, they will have to remit at the lower level. The doctors can never go back and recoup the money that they should have been paid.

This is a crisis that is not necessary. We can fix this. We can fix this in the CR. Unfortunately, congressional Democrats, the minority leader on the House side, and the Finance Committee chairman on the Senate side are blocking this very simple fix from occurring. It is wrong. It needs to change.

Mr. Speaker, I thank the gentleman for holding this Special Order hour.

Mr. Speaker, I thank the gentleman for yielding and for holding this Special Order to discuss the issues of the impact of the Medicare cuts.

In rural communities, like where I serve in south central and southwestern Pennsylvania, seniors rely on Medicare to see their doctors, to fill their prescriptions, and to take an ambulance in case of an emergency. Now, these patients are in serious danger of losing access to their trusted healthcare providers.

Medicare pay cuts, when compiled with 4.6 percent medical inflation, result in increased barriers to care for Medicare beneficiaries.

Let's be clear about what these cuts mean for a Medicare patient, and these cuts, for everyone's information, have already gone into effect on January 1.

These cuts mean that rural and small providers will be forced to restrict access to Medicare patients and, in dire cases, will be unable to keep their doors open at all.

As a doctor, I understand firsthand the negative impact that these significant year-after-year cuts have on rural providers.

Now, extrapolate that and then compound that with already existing workforce shortages in underserved areas like my district in rural Pennsylvania. I can assure you the repercussions are dire. These cuts jeopardize physicians' ability to provide quality care for elderly patients in our communities.

When physicians who participate in Medicare are increasingly being forced to do more with less, it is ultimately the patient who will suffer. These cuts will accelerate practice consolidation and force patients into higher cost settings for care. It will mean longer travel times and longer wait times for patients to see their family doctor, to see a surgeon, and to see a specialist.

As physicians and as legislators, we have an obligation to work to find a solution for Medicare patients. Congress must step in and address these cuts before they do any additional damage to our healthcare system.

Mr. Speaker, I thank the gentleman for holding this Special Order hour.

Mr. Speaker, I thank the gentleman for yielding.

Mr. Speaker, it is rare in this Chamber, especially recently, that you find a bipartisan effort, especially one that is all about the people. In this case, it is about the people.

You have seen several physicians and several people from different committees from all over the Nation agree on one thing: We are not doing the right thing.

By cutting Medicare payments to individual practitioners, we have done the opposite of the right thing. We will consolidate healthcare. You lose the cheapest way to deliver healthcare to the most people.

Right now, hospital systems employ 71 percent of all physicians, and that is going up every year.

Physicians deliver healthcare at the lowest possible rate. That is a fact. By doing the Medicaid payment cuts just to physicians, not to hospital systems, just to physicians at this quantity, you are forcing more physicians to work for hospitals, which means less competition and higher prices. That is the end-all be-all to what is going to happen right now.

It is not going to save more money. It is going to mean more consolidations, more monopolistic practices, higher prices, and worse access, because physicians simply won't be out there to accept you as patients.

You will have people retire; you will have people go out of business. When those physicians aren't there to take care of you at the most rudimentary level, the best and more affordable level, you will have nothing but worse patient care and a worse environment for physicians.

Therefore, I do recommend, just like my colleagues on both sides of the aisle, to do the right thing. If people in Congress on both sides of the aisle are demanding to do the right thing, why can't we make it happen?

Mr. Speaker, I encourage all of us to stand with our fellow physicians in a bipartisan effort to pass legislation to prevent cuts to the Medicare payments to physicians.