Surgeon Experts Highlight a Core Problem of Medicare Payment Reform in Health Affairs

The ACS has long advocated for reform of the flawed Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule (MPFS), particularly in response to the agency’s recent efforts to increase primary care reimbursement at the expense of specialists, including surgeons.

In a free-access Health Affairs article published last week, “Modernizing the Medicare Physician Fee Schedule: What Problem Are We Trying to Solve?,” ACS leaders and surgeons outline their concerns with this ongoing shift.

They argue that the “underlying thesis” of the shift—that primary care physicians are uniquely burdened by uncompensated care, with downstream effects on salaries, medical trainee interest, and public health—is misguided, noting that the evidence supporting these claims is outdated or lacking. 

Because the MPFS is required to be budget-neutral, meaning increases in primary care reimbursement must be offset by decreases elsewhere, surgeons are facing recurring payment cuts despite the growing complexity of their work. At the same time, a series of policy and Current Procedural Terminology code changes has led to higher reimbursement for primary care physicians.

The authors note that achieving a sensible and equitable payment system will require a thorough evaluation of recent MPFS adjustments to address existing flaws and ensure that surgical specialty care is valued equally with primary care.

Ultimately, though, this issue is not primary versus specialty—it is about protecting the full continuum of care. Primary care is essential, but it is not a cure-all for the nation’s health challenges, and patients also need ongoing access to surgeons and the lifesaving, complex care they provide.

The authors of the article include six surgeons:

• Christopher P. Childers, MD, PhD, member of the ACS General Surgery Coding and Reimbursement Committee (GSCRC)
• Christopher K. Senkowski, MD, FACS, Chair of the ACS GSCRC
• Don J. Selzer, MD, FACS, ACS Regent and Vice-Chair of the ACS GSCRC
• Charles D. Mabry, MD, FACS, member of the ACS GSCRC and Past ACS First Vice-President and Regent
• Michael J. Sutherland, MD, MBA, FACS, ACS Senior Vice President, Member Services
• Thomas C. Tsai, MD, MPH, FACS, Medical Director for Health Policy Research in the ACS Division of Advocacy and Health Policy