Veasey Asks Doctor How Difficulties In Running Practice Are 'Compounded' By Medicare Reimbursement

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[00:00:00]The gentle lady yields back. Now, recognize the gentleman from Texas, Mr. Veasey, for his 5 minutes of questioning. Thank you, Mr. Chairman. Uh when we talk about the Medicare physician fee schedule, I think it's important to remember that this conversation is not just about Medicare beneficiaries.

[00:00:15]Uh the way Medicare reimburses physicians affects access to care for all Americans uh because it influences who becomes a doctor and what sort of specialty they might choose uh and whether they can afford to practice independently uh to in our communities. Uh and you'll talk to medical school students and you'll ask them uh what kind of doctor do you want to be?

[00:00:40]Uh and they quickly learn that primary care physicians are reimbursed at a far lower rate than other specialties. Over the course of their career, that can mean millions of dollars in lost earnings uh potentially compared to higher paying fields. And students respond to those financial realities, which we clearly see in the residency match rates. Uh and while specialties like orthopedic and uh neurosurgery fill 100% of residency slots, family medicine only filled about 83% of their slots this year. Of course, Medicare reimbursement is not the only factor influencing specialty choice, but it's definitely a significant driver. Uh and now we are facing a severe primary care physician shortage. Uh by 2038, America will be about 70,000 primary will be short about 70,000 primary care physicians. Uh this is the number of primary care physicians required to staff every primary care clinic in Texas, California, and New York combined. Uh Dr. Fox, I wanted to ask you uh to what extent uh is the way Medicare reimburses for primary care influencing what specialty medical students decide to pursue?

[00:01:50]Thank you, Congressman. We know that choice of specialty is influenced by future earning potential.

[00:01:56]So, we know that and the studies uh demonstrate this that our trainees, our learners, our medical students are not choosing to go into primary care, which is the one field that has been shown to decrease overall costs of care.

[00:02:10]>> Yeah. Yeah. Yeah. So, um after residency, you know, young physicians have to ask themselves, "I want to open my own practice or work for a large hospital system." And for independent physicians, the barriers can be enormous. It doesn't matter the payer mix. Running a private practice means taking on administrative burden, staffing costs, uh rising overhead. I know a OBGYN in the Grapevine, Colleyville area that just went to that just closed their practice down and went into another practice because of this.

[00:02:38]Uh then add uh that to a Medicare physician fee schedule that has effectively reduced uh physician reimbursement by over 33% over the last 25 years. And meanwhile, hospital systems offer guaranteed salaries, administrative support, and far less financial uh um uh uncertainty. Uh so, uh for a young physician carrying hundreds of thousands of dollars in student debt, trying to start a family practice um can can can can really be tough. Uh and while hospitals play a critical role in our health care system, independent health care matters, too. Not everybody wants to be a hospitalist. Doctor uh Snyder is someone who owns a private practice back in DFW. Can you briefly explain how the challenges of owning a practice are compounded by Medicare reimbursement policy, especially in a lower-income area like the one that I represent in DFW?

[00:03:31]Yeah, what when I was president of Texas Medical Association 3 years ago, we talked about this. One of the things I went around all the state was to meet with all of our physicians in West Texas, East Texas, rural areas, urban areas, and try to learn about their frustrations and and burdens. And the Medicare fee schedule was always at the top of the list, especially amongst the independent physicians. And now, it was a cut and compared to the value and cost that they were trying to provide patients. And I would have very emotional discussions, especially with some primary care doctors, that they would have to make the very emotional and heart-wrenching decision about closing their practice and joining a uh hospital employed model, which they really didn't want to, or to go to concierge model. Which when that happens, about 2,000 patients just lost their primary care provider because they're focusing on giving the access, the time that they want to to about 500. So, these are all very heart-wrenching decisions, and it's all coming back to the same thing. The Medicare physician fee schedule is not a viable reimbursement mechanism for a lot of independent physicians. And so, a lot of them are again making that decision to stay, try to stay independent, or make other choices. Yeah. Yeah, I think whether you're in a rural county or major city, or whether you have private insurance or Medicare, uh you have access to fewer independent primary care physicians than you did a decade ago. And I don't think that that's good for the public. Uh that's going to result in in in higher costs, less competition, longer wait times.

[00:05:02]It's just it seems like a bad outcome for everyone. Mr. Chairman, I yield back.