Medicare and Medicaid funding is determined yearly by the U.S. Centers for Medicare and Medicaid Services, which is also know as CMS. Throughout the year, they discuss the needs of the general population of members and nonmembers to determine where funds need to be allocated. This practice is supposed to ensure that a wide range of generalists and some specialties are largely covered by CMS, giving those who use the service a chance to see whatever type of preliminary doctor they need before determining if they need a specialist.
Of course, these choices are often heavily debated as giving funds to one group to expand service often means cutting them away from existing services. While the numbers might support the choices made by the CMS, the patients and providers do not always agree. Groups that have their services cut or those who think the financial allocations are unfair are often the first to start a call to action, urging practitioners and patients alike to let CMS know that you disagree with their choices. Of course, actions like these are entirely within the guidelines of how these groups interact. Speaking up if you feel wronged is a great way to get the conversation rolling on how to create a better balance, but before you sign up for any call to action, make sure that you are aware of the situation and know the full story of what you are fighting for.
Cuts and What They Mean for You
For the final 2023 Medicare Physician Fee Schedule, cuts were seen in multiple departments, affecting the pay of Physicians for over 27 different specialties, including physical therapy, ophthalmology, and more. The cut has moved back and forth in recent months, only just settling on 4.5% towards the end of November.
These cuts directly come from what CMS will be paying to physicians when they treat patients who are covered by Medicare or Medicaid. This ultimately leads to several possibilities, none of which are exclusive. In order to validate the cost of the treatment, patients will have to pay more on their end to make up for what CMS is no longer paying. It is equally possible that some physicians simply pull away from CMS and choose to no longer accept them as insurance, meaning that the options for finding providers can dwindle.
The money that was taken from one area of funding ended up opening several new avenues that CMS is hoping will be more beneficial to members and nonmembers alike. CMS is creating more affordable options for those in need of services such as dental or behavioral health. While those who are in-system are feeling put off by having their funding cut, the numbers show that there is a growing need for more opportunities like these, hence why CMS is turning to them.
There could be right and wrong to see on either side. Is it right to take away funding that both providers and patients who are already using it depend on? Is it right to not cover the needs of others when the basic needs and more are being covered for some? Is there no additional way to adapt the funding so no programs are suffering? Tell us your thoughts on the matter today!