Medicare Doc Payment Fix Bill Moving Along, GOP Doctors Caucus Co-Chair Says

Rep. Greg Murphy, MD (R-N.C.), co-chair of the House GOP Doctors Caucus, said on Friday he is hopeful that his bill to reverse the cut in the Medicare physician fee schedule will get a hearing in the House in the next week.

“I have spoken with the speaker [House Speaker Mike Johnson (R-La.)], the [House Majority] whip, the Ways and Means [Committee] chairman, and multiple other members of the Doctors Caucus, and doctors are supportive,” he told MedPage Today on Friday in a phone interview at which a staff person was present. “We’re working through the machinations of trying to get this on the suspension calendar for next week, which means two-thirds of the House has to agree with it. It is my belief that this will happen.”

Murphy, a urologic surgeon, emphasized that although he still sees patients, “congressional laws forbid me to receive remuneration. So this is not to be seen as me trying to help myself get paid. This is because I care deeply about my colleagues. I care deeply about patients and their access to see a doctor.”

At a time when 10,000 new Medicare patients are being added to the rolls each day, there is “an ever-increasing doctor shortage, especially in rural areas,” he said. “The continual cuts that physicians get — 21% inflation-adjusted over the last 20 years — will absolutely exacerbate the problem, with early retirements and increased burnout, etc.”

In November, the Centers for Medicare & Medicaid Services (CMS) finalized a nearly 3.4% cut in physician payments for 2024, which took effect on Jan. 1; Murphy’s bill, the Preserving Seniors’ Access to Physicians Act, would layer a 4.62% payment increase on top of that cut, giving doctors in effect about a 1.22% Medicare pay increase. Sometimes, doctors will hold off on filing their January Medicare claims to see whether congressional “fixes” like Murphy’s get passed; such bills also often include a “retroactive” component to apply to claims filed early in January when nothing had been passed yet.

Some other bills now floating around Congress feature smaller increases, including a bill in the House Energy & Commerce Committee that adds a 1.25% payment increase, “which is effectively a cut of almost 2%” once the CMS cut is included, Murphy said. “My thought is, why are we cutting doctors at all? There’s no other profession in this entire nation that expects to be cut every year. And so as far as I’m concerned, those [other] bills, while they’re nice, they don’t go nearly far enough in just keeping those who actually take care of patients whole.”

Medicare cuts aren’t the only thing on Murphy’s healthcare agenda. On Jan. 3, he sent a letter to FDA Commissioner Robert Califf, MD, discussing his concerns about the role of artificial intelligence (AI) in healthcare. The letter noted that although AI will transform care “in ways we never thought possible” and has the capacity to make physician care more efficient, the FDA needs to consider consumer safety and proper guardrails when it develops regulations. The letter also asked for the agency’s response to a series of five questions on its position on AI and any regulatory actions it has taken.

“It’s critical to make sure that there are safeguards in place — that it doesn’t control us, we control it,” said Murphy. “How do we put safeguards in it to make sure liability concerns are taken care of? What type of safeguards are there for patient care and physicians who take care of patients?”

For instance, he continued, “what if AI recommends a particular type of care, but the physician disagrees with that and the physician does what he believes is clinically best? But maybe there’s a less than optimal outcome; is this now going to be an entirely new marketplace for malpractice [litigation] for doctors that didn’t agree with the AI determination? We have to be very, very careful about this from the beginning.”

Murphy said he is awaiting a response from the FDA. “I met with the FDA 6 to 8 weeks ago and they said they’re working on this, so I think we’ll have a very good partner with the FDA … but I want to make sure they know that not only as a member of Congress but as a practicing physician, that we’re watching closely on how this is dealt with.”

Another area of interest is conscience protections for medical students as it relates to medical school accreditation. “The Biden administration is now trying to peel back the Trump administration’s ruling essentially that medical schools cannot force students to do things against their conscience” — usually related to performing abortions, although it also sometimes includes end-of-life decisions as well, Murphy said. “The Biden administration is now not protecting people, not saying they can practice according to their conscience.”

Although the current policy does allow students to opt out of courses they object to, such as abortion training, “remember that professors and administrators are in positions of authority, and a chairman can fire a resident at will,” said Murphy. “If you don’t go along with what the chairman wants, and you opt out, you’re subjecting yourself to risk of retaliation.” He said he would prefer to see an “opt-in” option instead. Murphy and two other GOP Doctors Caucus members wrote to Rep. Robert Aderholt (R-Ala.), chairman of the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, seeking action on this issue.

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