Small-practice physicians are getting squeezed by the system
.......................................... Rick Christie ..................................... Tony Doris
THE PALM BEACH POST EDITORIAL BOARD mission is to articulate the issues of the day, advocate for policies for the betterment of the community and encourage a civil and robust exchange of ideas. The Board consists of Executive Editor Rick Christie, Editorial Page Editor Tony Doris and Editorial Writer Douglas C. Lyons.
There’s something comforting about the idea of a small-town doctor. One who you may run into at the high school football game or who will ask about your family in the checkout line at the grocery store. And while that may seem a simple idea, the truth is that a connection with patients is why many doctors are drawn to medicine in the first place.
However, growing financial instability in the Medicare physician payment system threatens independent doctors’ ability to keep their doors open in Florida and nationwide – particularly in rural communities.
Congressional action is desperately needed to save small, independent practices to ensure Floridians continue getting care from their local doctors. Congress should seize the opportunity to modernize Medicare’s reimbursement rules and help fix the major problems that threaten to reduce patients’ access to care.
Medicare policies should treat physician payment the same way that they treat hospitals, skilled nursing facilities, and other providers. Unlike other Medicare providers, such as hospitals and nursing homes, physicians are the only ones whose Medicare payments do not automatically receive an annual update based on inflation. While other payment rates are adjusted to account for the inflation that impacts all other aspects of the economy, Medicare essentially reimburses doctors at 2001 prices for care provided at 2023 costs. Chronically underpaying community doctors is unsustainable.
With reimbursement rates failing to keep up with rising costs, more and more physician offices are struggling to keep their doors open. If reimbursement continues to fall well short of the cost of providing care, it is likely that many doctors will be forced to make unthinkable decisions such as cutting back services and staff, no longer accepting Medicare patients, or closing down altogether. All of these options would hurt Floridians’ access to healthcare and exacerbate the current shortage of doctors in the United States. To ensure patient access, the federal government must do its part to ensure physicians are fairly compensated.
Thankfully, lawmakers in Congress are working to address this pressing problem. A bipartisan group of physician legislators in the House of Representatives have introduced the Strengthening Medicare for Patients and Providers Act (H.R. 2474), legislation that would enable physicians to begin receiving annual inflationary updates based on the Medicare Economic Index for Medicare physician services, similar to what other types of health care providers receive. Bipartisan leaders in the House also recently introduced the Preserving Seniors’ Access to Physicians Act of 2023 (H.R. 6683), which will prevent a serious new Medicare cut for physicians from going into effect on January 1.
These commonsense solutions would treat physicians more fairly and help inject stability into their practices, especially those hit by the combined forces of the pandemic, soaring inflation, rising medical costs, and ongoing workforce challenges. If we allow these issues to go unaddressed, the physician shortage will get worse and the incentive for much larger, big-city practices to gobble up small-town practices will increase, undermining patient access and affordability in rural communities throughout Florida.
Changes need to be driven by policymakers in Congress. A fair payment system that provides financial stability and recognizes fiscal responsibility while promoting innovative, common sense, valuebased care, is desperately needed. Such a solution would go a long way toward ensuring seniors’ access to care.
To be certain, the Strengthening Medicare for Patients and Providers Act and the Preserving Seniors’ Access to Physicians Act won’t solve every issue, but they are a major step in the right direction.
Ensuring Medicare payments to physicians are in line with what hospitals and other providers receive makes sense for everyone. Congress should pass these bipartisan bills as quickly as possible so physicians across the country can help expand access to high-quality, comprehensive health care.
Joseph Nezgoda, MD, MBA, is a retina specialist in Boca Raton.
Where are the demands on Hamas?
The world has turned against Israel. I agree that horrific things are happening to the Gazan people, but the world seems to have forgotten why this is happening.
On Oct. 7, Hamas, along with other terrorist groups, perpetrated the most horrific, inhumane massacre on the Israeli people. That is the reason for the devastation in Gaza. Israel is being demanded to “ceasefire.” Why is Hamas not being demanded to surrender? They caused this.
There are horrific ethnic wars all over the world, but the United Nations does not demand ceasefires. Only Israel is told to stand down. People wondered why the Jews did not fight back in Europe in the 1930’s. Now they are fighting back, and they are being castigated for it. Where is Justice? Demand the surrender of Hamas and then the suffering of the Gazans will stop.
Marcia Halpern, Palm Beach Gardens
Teacher’s ‘Gaza’ concerns badly misplaced
Re the email by the Palm Beach County elementary school teacher: Hamas, a well known terror organization supported by 75% of the Palestinian people as evidenced in their last election, attacked young people enjoying a concert dedicated to peace. They murdered citizens, raped young girls and adult women and invaded kibbutzim. As any nation would do, Israel fought back, first advising Gazans to seek shelter, and then returning to eliminate their enemy.
This teacher writes of humanity, religion, and race and the respect of tolerance.” Who is she kidding? She should have asked why her countrymen and women voted for Hamas to lead them and why no Arab country provided sanctuary during the time they were given opportunities to find shelter. Our superintendent
Of course college students protest Israel’s actions in Gaza; to them nothing existed before they started following the news, perhaps 10 years ago. Of course college administrators avoid public announcements; they fear losing their jobs because of strident critics. Of course Palestinian supporters condemn Israel and ignore Oct. 7; that’s the essence of partisanship. The resulting noise makes a bad situation worse.
But few people know the history. Israel was created some 75 years ago as the only Jewish state in the world. As Golda Meir said, “We have nowhere else to go.”
True, it’s in the middle of a huge Muslim area that wants it gone but such opposition would likely happen any where else in the world. What has been forgotten by many, perhaps conveniently, is that for 75 years the Palestinians have turned down every twostate solution. For the Israelis this war is about existence. They understand that, “from the river to the sea” means the elimination of a Jewish state. Do college students?
For its first 25 years, Israel was attacked again and again by several Arab nations. It not only repelled the invaders but also gained land. As an unexpected result of the 1973 Yom Kippur War, the Arab nations changed their tactics. They stopped invading and employed the Palestinians as proxies to fight on their behalf. For 50 years those nations have operated behind the scenes. In support of this strategy, they won’t allow the Palestinians to settle in their countries. So for 50 years, the Arab nations have avoided direct conflict with Israel; the PLO, Hamas and Hezbollah became of schools has enough problems without an e-mail from a disgruntled teacher.
Robert Langer, Palm Beach Gardens
No news in wealth concentration story
Re the Post’s Dec. 11 front page article warning against “extreme concentration of wealth (that) could bide ill for the nation as a whole:” It already has. The Tea Party movement and its end result, the MAGA cult of Donald Trump is directly based on economic inequality, with the low and middle class feeling that the government works against them.
Since Reagan, there have been four Republican tax cuts, which have underfunded government creating huge financial benefits for the upper 1% with no economic benefit for the country. Deregulation also has been inflationary in primary industries where there is little competition, with price increases far greater than the inflation rate. Hopefully, between now and the November elections next year, Biden and the Democrats will properly message the blame for this wealth situation and propose a legislative agenda to reverse this wealth problem.
Daniel Jacobson, Lake Worth
US must free Evan Gershkovich
It’s time for America to do something about the Wall Street Journal reporter, Evan Gershkovich. He is an American unjustly imprisoned in Russia. Being nice has had no effect. Strong measures are needed. I suggest the U.S. bring our ambassador back and advise all Americans to leave Russia as soon as possible. Finally, impose severe economic sanctions on Russia. When this is accomplished, start negotiations to release Mr. Gershkovich. I believe the results will be better.
Charles Winfield, Boca Raton their proxies as guerilla warriors. For 50 years no Arab nation has attacked Israel.
The guerilla warfare changed on Oct. 7, when Hamas slew some 1,200 Israelis and kidnapped about 240 more. As we all know, Israel responded forcefully. Many people believe Hamas expected Israel to respond forcefully. It’s possible that Israel’s massive reaction is intended as intimidation; they may hope it will prevent similar attacks for another 50 years.
The irony? All the Palestinians and the other Arabs have to do in order to stop the fighting is recognize Israel’s right to exist as a Jewish state — and to mean it. The only alternative is for Israel to disappear.
Richard Kalman is a resident of Boynton Beach.