MGMA, representing over 60,000 medical practice administrators and 15,000 group medical practices, urgently calls on Congress to address the imminent Medicare payment cut and prioritize rural healthcare. Unsustainable reimbursement systems hinder patient access to rural healthcare. MGMA advocates for an annual inflation-based physician reimbursement update, an extension of the exceptional performance bonus, and more funding for medical residency positions. They also stress the importance of prior authorization reform and positive incentives for rural practices transitioning to value-based care. MGMA’s overarching goal is to ensure sustainable financing and access to quality healthcare in underserved areas.
The Medical Group Management Association (MGMA) has conveyed a critical message to Congress, highlighting the pressing need to address the impending Medicare payment cut and instigate reforms in prior authorization to enhance access to rural healthcare.
MGMA, representing a vast community of over 60,000 medical practice administrators, executives, and leaders, along with more than 15,000 group medical practices, asserts that the existing reimbursement system for physicians and healthcare facilities in rural areas is unsustainable. This financial instability is severely impacting patient access to healthcare in these regions, with rural providers struggling to maintain their services.
In response to a Congressional Request for Information (RFI) aiming to explore ways to improve healthcare access in underserved rural areas, MGMA underscores that the current financial challenges are a major impediment to enhancing care access for these populations.
MGMA contends that a well-functioning and equitable reimbursement system is a fundamental requirement to enable medical groups to offer high-quality care to Medicare beneficiaries. Over the past two decades, the operational costs for medical practices have nearly doubled, while Medicare physician reimbursement rates have seen a mere 9 percent increase, as per MGMA’s data analysis from the American Medical Association (AMA). A recent MGMA Stat poll in July 2023 reported that 89 percent of medical groups have experienced rising operating costs.
As operational costs soar, physicians are effectively facing a decline in revenue due to inflation eroding the impact of modest reimbursement rate increases. Furthermore, physicians under the Medicare Physician Fee Schedule are slated to encounter a 3.36 percent cut in 2024, which MGMA deems unsustainable for medical practices.
In response to these challenges, medical practices indicated in a survey conducted the previous year that they would contemplate various measures, including limiting new Medicare patient intake, reducing charity care, downsizing clinical staff, and closing satellite locations.
MGMA urgently implores Congress to prevent Medicare reimbursement cuts to safeguard access to care in rural areas. The association also advocates for an annual inflation-based physician reimbursement update as a preventive measure to curb further financial strain on rural medical groups, as seen in recent legislation called the Strengthening Medicare for Patients and Providers Act, which proposes tying physician reimbursement to the medical economic index (MEI).
Additionally, MGMA calls for an extension of the exceptional performance bonus under the Merit-Based Incentive Payment System (MIPS), which expired at the end of 2022. The association asserts that this bonus is crucial in helping physician practices meet the demanding MIPS requirements, particularly as rural, small, and medically underserved practices have faced disproportionate challenges under MIPS.
Beyond sustainable financing, MGMA underscores the need for changes in workforce management, prior authorizations, and the implementation of value-based care to bolster rural healthcare access. The association advocates for:
1. Increased funding and support for the Graduate Medical Education Program, along with additional Medicare-supported medical residency positions.
2. Reform in prior authorization procedures, including updates to acts such as the Improving Seniors’ Timely Access to Care Act, The GOLD CARD Act, and the Reducing Medically Unnecessary Delays in Care Act.
3. Positive financial incentives to assist rural practices in transitioning to value-based care, including an extension of the Alternative Payment Model (APM) incentive bonus at 5 percent.
4. Enhanced support for practices transitioning to APMs, including flexibility in setting qualifying participant thresholds by CMS to encourage APM participation.
5. Development of physician-led value-based care models tailored to succeed in rural and underserved communities.
