Physicians grapple with reimbursement challenges

As reimbursements from CMS and other payers continue to be misaligned with the cost of keeping practices afloat, physicians face difficult choices about how to lead their practices into the future. 

"In the short term, as cuts to physician pay continue, more physicians will opt for employment or direct-care models," Mohammad Agha, MD and Medical Director of Care Coordination for SSM Health told Becker's

Between 2012 and 2022, the portion of physicians who worked as employees grew to 77%. According to the Physicians Advocacy Institute and Avalere Health, 58.5% of practices are health system or corporate-owned and reimbursement challenges are frequently cited as a main reason that physicians opt for employment over independence. 

"On the whole, the biggest threat to physicians in 2024 is consolidation and integration with private equity, employed relationships and being out-leveraged by the payer community," Ben Mandelbaum, MD, an orthopedic surgery professor at Cedars-Sinai in Los Angeles, told Becker's

Many foresee the cuts resulting in many independent physicians being forced to accept less Medicare patients or not accepting them at all. 

"This will be the last straw for many private practice physicians," Ernest Braxton, MD, a spine and neurological surgery specialist of Vail, Colo.-based Vail-Summit Orthopaedics and Neurosurgery told Becker's. "We will see more early retirements and a large number of physicians opting out of Medicare in order to create private pay contracts with patients for non-urgent/emergency care, shifting the economic burden to healthcare consumers."

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