Physicians in North Carolina are warning that what they describe as Medicare's outdated payment system is putting patient care on the line, especially in rural communities.

For years, Dr. Sreejit Nair's practice, Sunrise Vascular, has provided specialized vascular treatments to patients who would otherwise need to travel hours for care. Now, because of ongoing Medicare cuts, Nair said he fears without immediate reform, his patients and many others in underserved areas could lose access to life-saving treatments.

"It's already too late for many practices," he said, "and there are a few of us that are still trying to hang on for dear life, trying to still provide these desperately needed services to areas of the country where there's no other option."

The problem stems from Medicare's Physician Fee Schedule, which has slashed payments to lower-cost private practices such as Dr. Nair's, while increasing them for higher-cost hospital-based services. The imbalance is pushing many private practices to the brink of closure, leaving patients with fewer options for affordable care.

The Office-Based Facility Association is advocating for reforms to pull high-cost supplies and equipment out of the fees currently covered, and create a new payment model for office-based providers.

Jason McKitrick, the association's executive director, said these changes would still reimburse for these supplies, and be the lifeline for these smaller medical practices.

"Over the last few decades, as the technology advances have allowed those services to move from the hospital to the office-based setting," he said, "the money hasn't gone with it."

He said Medicare's own data show what is reimbursed today doesn't cover the direct cost of care or doctor's salaries for at least 300 office-based services.

McKitrick stressed that without these reforms, the burden will also fall on patients, who'll have to seek more expensive care.

"When these centers shut down, they have to go to a higher-cost site of service - and in many states, the only other option is a hospital," he said, "and so, they're paying up to five times more for some services."

He said this affects patients who need all types of care, from physical therapy to oncology and even cardiac surgery. He suggested that prompt legislative action is critical.

Minnesota has 120 hospitals designated for treating stroke patients but health leaders say more work is needed to reach underserved populations.

The region is getting a nearly $5 million grant to help address the gaps. The American Heart Association and the state health department announced the new funding this week.

Officials said the grant has a pair of key components. One is a public awareness campaign to provide multilingual and culturally relevant messaging on the signs of a stroke and preventive care.

Dr. Haitham Hussein, neurologist at the University of Minnesota and past board president, Twin Cities American Heart Association, said it will be crucial, because his research has shown some eye-opening disparities.

"There was a gap in arrival to the hospital," Hussein explained. "Nonwhite individuals arrived much later, about eight hours later to the hospital when they had a stroke, compared to white individuals."

He pointed out it means limited-English-speaking patients are not getting the necessary medication in quick enough fashion to reverse the effects of a stroke. Another priority of the grant is to implement care standards across the state for people recovering from a stroke, especially for those facing care gaps in rural settings.

Altogether, Hussein emphasized the bookends from the new investment should complement the work Minnesota has already done in building a stroke care system for the region.

"It really addresses gaps that we see every day in our practice," Hussein stressed.

The American Heart Association said the funding, provided by the Helmsley Charitable Trust, will be spread across three years. It will also focus on data collection across diverse types of rehabilitation facilities as a way to guide future care improvements.

Health-care advocates say more than 1 million North Carolinians could lose access to health care if the promises made in Project 2025 are carried out. Project 2025 is a 900-page "playbook" written by the conservative Heritage Foundation for a complete makeover of the federal government if Republicans win a governing majority in the next election.

DonnaMarie Woodson, a longtime Charlotte-based health-care advocate and political activist who lobbied Congress to create the ACA, said Project 2025 would be a disaster for both low-income families and all Americans.

"Project 2025 is a vision of a world, a country that nobody wants to live in. It's all about control, because if we can't agree on human life being valuable, then there's no place else for us to go," she said.

Project 2025 calls for a takeover of most government agencies, changing the way they operate to conservative principles and staffing them with right-wing ideologues. It would make some independent agencies directly responsible to the president, and close altogether others such as the Department of Education and the EPA.

Woodson said programs such as the ACA and the Inflation Reduction Act relieved many North Carolinians, including her and her husband, from regularly deciding whether to pay monthly bills or get health care. Woodson is a two-time cancer survivor and her husband is an insulin-dependent diabetic. The state's adoption of the ACA Medicaid expansion was a lifeline, she said.

"It was like 600,000 people signed up for Medicaid, which was supposed to be a part of the Affordable Care Act, but there were states that did not accept the free money that was coming to the state because of politics," said Woodson.

Woodson added Project 2025 goes far beyond just reshaping the government and would turn daily life in America into a "dystopian nightmare."

"Who wants to live like that? You don't really even hear the word service working with the government. Senator this, Representative that, but they're all supposed to be servants of the people. That was the whole point of having the United States -- so all of us would be united as a community," she continued.


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Shopping for health-care procedures has historically been more challenging than getting the best deal on groceries or even car repairs.

But Cari Frank, vice president for communications with the Center for Improving Value in Health Care, said you can now compare prices for more than 250 procedures - from having a baby to imaging services and getting a hip replacement - across 150 hospitals and other care facilities across the state, through the group's updated Shop for Care Tool.

"You can shop for what facilities might be the lowest cost and the highest quality around you. So, you can really save thousands and thousands of dollars by using this tool," she explained.

The tool taps data from the Colorado All Payer Claims Database, which shows that commercial insurance companies have paid between $270 and $2,000 for a single cardiovascular stress test. An ultrasound of the heart can cost between $700 and $4,000. The tool is online at CIVHC.org.

Because quality is not always synonymous with cost in the health-care sector, the tool now ranks factors including a facility's success rate in positive health outcomes, and whether or not their services meet national guidelines.

"And then there is also a quality measure that's the patient experience. So it's, 'How does a patient feel like they were treated when they were there? Did the doctors respect them? Were they given good discharge information?' Both of those scores are available on our tool," she continued.

Frank hopes the tool will help bring down health costs by making prices more transparent and giving consumers options. She adds if you're getting a knee replacement, for example, it's important to consider the procedure's overall price tag, not just out-of-pocket costs.

"Even if you are only going to have to pay $500 out of pocket, that $60,000 total price tag does get factored into your premium setting the next year, which means that prices might rise for you overall," she added.