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IL doctors seek revisions to their Medicare reimbursement amounts

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Wednesday, November 20, 2024   

The number of Medicare enrollees is projected to rise over the next few years as the baby boomer population ages. More than 2 million Illinoisans are currently enrolled in the federal health care program, according to Healthinsurance.org,

The Office-Based Facility Association, a coalition of practitioners, is calling for a change in what they view as an ineffective and unfair pricing structure of the Medicare Physician Fee schedule.

Jason McKitrick, executive director of the association, said other payers linking themselves to Medicare is one of the issues.

"When you've got ongoing cuts to Medicare, that means you've likely got ancillary cuts going on with the private side, with the Medicaid side, etc.," McKitrick explained. "It's the Centers for Medicare and Medicaid Services, CMS, ultimately, that's the agency and the federal government that sets the rates for the Medicare Physician Fee Schedule."

The association pointed out the current fee schedule addresses doctor's fees only, not the costly and necessary supplies and equipment needed for their practices. According to the Centers for Medicare and Medicaid Services data, there are 300 office-based services under the fee schedule for which Medicare reimbursement is less than the direct costs, before even considering other costs like overhead and physician work.

Dr. Sreenivas Reddy, a vascular interventional radiologist in Hinsdale, said in addition to seeing patients, he has to monitor overhead expenses such as office space and employee salaries, both affected by inflation. Not having the proper medical equipment and supplies, he added, limits his ability to perform specialized procedures and forces patients to seek care elsewhere.

"That makes these patients go to the hospital-based facilities," Reddy noted. "We have to close our offices and try to join these hospital-based models. They would love to come to the office, get the procedure done in one or two hours, versus it takes like a whole day in the hospital setting."

Reddy emphasized physicians' reimbursement, based on the current physician pay schedule, has been on the downtrend for the last five years. The group has further concerns about a decrease in the number of private practices causing more medical deserts for interventional radiology, cardiology, vascular surgery, radiation and oncology care.

Disclosure: The Office-Based Facility Association contributes to our fund for reporting on Consumer Issues, Health Issues, and Mental Health. If you would like to help support news in the public interest, click here.


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