HOUSTON – Millions of Texans are on Medicare, but its future lies in limbo as the U.S. Senate is set to vote for a new leader.
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Dr. Bruce Scott, President of the American Medical Association, sat down with KPRC 2 while visiting Houston to voice the serious concerns he and other medical officials have over Medicare’s current state.
“There’s this complex formula by which Medicare pays physician practices fees, and that formula is broken, and it has resulted in a continued cut and cuts for the foreseeable future, despite the fact that Medicare themselves say the costs are going up,” Dr. Scott said. “For example, we got almost a 3% cut starting January 1st of 2025, but they tell us that they think our costs are going to go up 3.5%. It’s unsustainable.”
Dr. Scott also said Medicare physician reimbursement rates have plummeted by nearly 30% since 2001.
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That isn’t just a problem for physicians who accept Medicare, Scott says, because insurance rates are also in line with Medicare.
“Every insurance company that I have a contract with ties their payment rate to the Medicare rate,” he explained. “But why wouldn’t they? They know it’s been a downward spiral for the last 20 years and so, they tie their rate to the Medicare rate. So, what that means is as a private practice doctor, I’m paid less by basically every single payer for what I do today versus what I did 20 years ago.”
Now, the American Medical Association is concerned that this is harming the patients. Dr. Scott gave examples of when patients feel frustrated by the system and forgo their doctor’s recommended treatment.
“I think the first solution is that we need to get a Medicare payment formula that actually pays physician practices linked to the cost of providing care,” he suggested. “The second thing we need to do is reduce some of the administrative burdens...the fact the physicians spent on average 13 hours a week filling out prior authorization forms. If we could take away half of that and give back six hours a week to all your primary care doctors, that would be six more hours of time to see patients.”
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Dr. Scott encourages frustrated patients to write to legislators. He said patients have more power than they think.
“I think that we need an outroar among the patients of America to say, ‘We need access to our doctors.’” he concluded. “Some of this has gotten ridiculous.”
