‘Serious setback’: New Medicare fee schedule undervalues infectious disease workforce
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The 2023 Medicare Physician Fee Schedule does not reflect the important role infectious disease physicians play in safeguarding public health and is a “serious setback” to the ID workforce, the Infectious Diseases Society of America said.
In a statement, IDSA President and Infectious Disease News Editorial Board Member Carlos del Rio, MD, FIDSA, said the rule “continues the longstanding practice of gravely undervaluing the contributions of infectious diseases physicians” at a time when having enough ID physicians is an essential priority for public health.
“Outbreaks of infectious diseases are emergencies that jeopardize public health and patient safety,” del Rio said. “The U.S. population has seen this up close for nearly 3 years, in ways not experienced in decades. One clear takeaway from the pandemic is that America needs more infectious diseases physicians to adequately meet the country’s needs.”
The AMA earlier this month criticized the new fee schedule as “ominous” because of a “4.5% across-the-board reduction in payment rates,” which includes an 8.5% cut in payments for physicians. Part of the cut includes a previous 3% cut averted by Congress last year that will expire in December.
AMA President Jack Resneck Jr., MD, said in a Nov. 1 statement that “it was immediately apparent that the 2023 Medicare physician payment rates not only failed to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also included the damaging across-the-board reduction.”
Aside from the multitude of clinicians and nurses working directly with patients, the mitigation strategies — from considering masking policies, to temporary walls and other methods of preventing the spread of SARS-CoV-2 — have been developed by infectious diseases specialists, who have continued to treat patients during the pandemic.
The concern, according to IDSA immediate past-president Daniel P. McQuillen, MD, is not having enough infectious disease clinicians because of salary restraints and hospital funding decisions at a time that the country needs a strong ID workforce.
“It’s no secret that hospitals and medical systems in the U.S. are driven by how much complex surgery they can do because the payments are so big,” McQuillen said. “And when you look at what that brings to the budget vs. what I bring to the budget, the attention goes there. But if you don’t have people who do what I do ... then pretty soon, the collapse will happen for different reasons.”
In general, the Medicare fee payment schedule pays higher reimbursements for specialties that use resources — and the schedule is largely built around resource-based care — according to McQuillen. “Those of us who practice in specialties that don’t have that extra resource that gets paid for get paid a lot less,” he said.
In addition to COVID-19, which McQuillen said basically added “another full-time job” to the workforce, ID physicians have been busy addressing RSV and influenza, along with the recent polio and monkeypox outbreaks.
“Infectious diseases physicians improve patient outcomes and lower health care costs for people with serious infections,” del Rio said. “They protect patients and the population at large by preventing, diagnosing and treating infectious disease.”
Both del Rio and McQuillen said Medicare’s “complicated payment system” devalues doctors who do cognitive work like devising strategies to prevent hospital outbreaks and limit infections.
Additionally, del Rio said roughly 80% of counties in the United States lack a single infectious diseases physician. Increased reimbursement is vital for building a more robust ID workforce, he said, because the cognitive work they do, beyond treating individual patients, helps protect “the population at large by preventing, diagnosing and treating infectious diseases.”
Previous data has shown that fewer young physicians are applying for ID training, and experts have said that the disparity in compensation between ID specialists and other specialties is among the reasons why.
The expectation among some was that the “Fauci effect” — a surge in interest during the COVID-19 pandemic in making a career out of medicine — might draw more people to the historically underserved specialty of ID.
“In the past couple of years, everybody in medicine has devoted a lot of time to trying to beat back COVID and get it under control. In many of those situations, the people that do what I do had to figure that out,” McQuillen said. “I realize CMS is in a tough spot in balancing all these competing interests, but at the same time I work for a specialty that has helped to save lives the last few years and the thanks is making less money.”
References:
- IDSA. Medicare physician fee schedule is a serious setback to a robust infectious diseases workforce. Medicare physician fee schedule is a serious setback to a robust infectious diseases workforce. Published Nov. 9, 2022. Accessed Nov. 16, 2022.
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