November 1, 2024 

Physicians across the country are facing mounting pressures. Reduced Medicare reimbursements, coupled with rising inflation, staffing shortages, and increased administrative demands, are pushing many healthcare practices to a breaking point. Over the past few years, Medicare payment rates have failed to keep up with the increasing costs of running a medical practice.

In 2022, the overall Fee-for-Service (FFS) Medicare margin hit a record low, reaching a negative margin of -11.6% even after federal relief funds.¹

This shortfall is not just an issue of balance sheets; it’s about maintaining access to quality care for millions of Americans.

As we approach the 2024 election, Medicare reimbursement reform is emerging as a pivotal issue. Both political parties propose different solutions, with critical consequences for the viability of small and independent practices.

This election will determine whether healthcare practices thrive or struggle to survive, and whether patients can continue to access essential services. And understanding the candidates’ stances is crucial to navigating an uncertain future. Let’s find out.

Candidate Positions on Medicare Reimbursement Reform

Kamala Harris: Equitable Access and Physician Sustainability

Kamala Harris supports Medicare reforms to address the financial pressures on providers. She wants physician payment updates to be inflation-adjusted so reimbursement rates keep up with costs. Her focus is on equitable access, pushing for policies that support small practices and high-quality, value-based care.

Donald Trump: Deregulation and Spending Cuts

Donald Trump’s approach is deregulation and cutting federal spending, including potential limits on Medicare funding. While deregulation might ease administrative burdens, Trump’s policies could mean more Medicare cuts, less revenue for practices, and less ability to serve Medicare patients. His position is a smaller federal government which means practices will have to manage tighter margins and operational challenges on their own.

2024 Payment Policies and Political Impact on Medicare Reform

Physician Fee Schedule (PFS) Updates

The 3.34% cut in Medicare’s conversion factor proposed by CMS for 2024 is a big deal.² Kamala Harris wants to offset those cuts with inflation-adjusted payment reforms to keep practices viable, especially for smaller practices. Donald Trump wants to reduce federal spending so those cuts will happen.

Value-Based Care Push

CMS’s value-based care incentives are another area of Medicare reform. Harris is for expanding those incentives to reward quality over quantity which could stabilize practice income for those in value-based models.

Trump doesn’t mention value-based care so it’s a more market-driven approach that could limit federal incentives for practices transitioning to those models. The candidates’ positions reflect different visions for care quality and reimbursement stability.

Legislation and Reform: A Hot Button Issue

HR 2474

The Strengthened Medicare for Patients and Providers Act (HR 2474) would update physician pay based on inflation which would close the gap between rising costs and stagnant Medicare reimbursement.³

Kamala Harris will likely support HR 2474 since it’s in line with her position on fair provider compensation and access to care. Donald Trump will likely be opposed to increasing federal spending on Medicare. His focus on cutting spending means he’ll likely be against reforms that increase reimbursement rates through automatic adjustments.

MIPS and MACRA

The Merit-based Incentive Payment System (MIPS) and the Medicare Access and CHIP Reauthorization Act (MACRA) have been a mixed bag for providers, with more paperwork and not much reward.

Harris is open to tweaking these programs, reducing paperwork, and making sure reimbursement is tied to quality metrics.⁴ Trump will likely leave these programs alone and favor a deregulated healthcare system. Under Trump, MIPS and MACRA will continue without much change, with all the complexity and administrative burden.

Equity-Focused Reforms and Health Access: Two Different Visions

CMS’s Equity Agenda

In 2024 CMS introduced initiatives to address health disparities by incentivizing care for the underserved communities and supporting whole-person care. These programs are about equitable access by paying practices that serve the marginalized and deliver comprehensive patient-centered care.

Kamala Harris is for equity in healthcare access so she’ll likely support CMS’s equity-focused incentives. She sees these reforms as key to closing healthcare gaps for the underserved.

Donald Trump is for reducing federal intervention so he may not support these programs. He wants to minimize federal spending and shift healthcare to the private sector so that will mean less support for programs that promote equity. This difference in priorities shows the two candidates have different visions for addressing healthcare inequities and fair access to care.

What it Means for Your Practice

Rising Costs and Practice Viability

The 2024 election will impact practice viability through Medicare reimbursement. Kamala Harris is for inflation-adjusted payments to help practices keep up with rising costs.⁵ Her approach will ease the financial burden, especially for small and independent practices.

Donald Trump will cut federal spending so that will mean more reimbursement cuts and practices will have to make tough decisions like reducing staff or limiting services to Medicare patients.

Access to Medicare Patients

Harris’s approach will make sure reimbursement rates match the economy so practices can continue to see Medicare patients without financial strain.

Trump’s cuts will limit reimbursement rates resulting in reduced access for patients, especially in underserved areas where Medicare is a major payer. The candidates’ policies will determine if Medicare patients can continue to get the care they need without disruption.

Final Words: The 2024 Election is the Time for Permanent Reform

The Call for Sustainable Reform

The 2024 election is the moment of truth for Medicare reimbursement. Permanent reform is needed to make sure reimbursement rates keep up with costs and the demands of modern healthcare. Sustainable Medicare policies are not just good for practice financials but for access to care across the country.

Healthcare professionals must stay informed and engaged to help shape policies that support their practices.

Sources

1. Medicare Payment Advisory Commission. March 2024 report to the Congress: Medicare payment policy. MedPAC.gov.
2. Centers for Medicare & Medicaid Services. Calendar year (CY) 2024 Medicare physician fee schedule proposed rule. CMS.gov.
3. U.S. Congress. H.R.2474 – Strengthening Medicare for Patients and Providers Act of 2023. Congress.gov.
4. Kamala Harris and Donald Trump on the issues, 2020-2024. Ballotpedia.org.
5. Kamala Harris and Donald Trump policies compared. Newsweek.com.