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New Medicare fee schedule underestimates infectious disease workforce

November 16, 2022

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The 2023 Medicare physician fee schedule fails to reflect the important role infectious disease physicians play in protecting public health and is a “serious setback” for the ID workforce, said the Infectious Diseases Society of America.

In a statement, the president of the IDSA and Infectious Disease News Member of the editorial board Carlos del Rio, MD, FIDSAsaid the rule “continues the long-standing practice of seriously undervaluing the contributions of infectious disease physicians” at a time when having enough physicians in ID is a key public health priority.

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“Infectious disease outbreaks are emergencies that put public health and patient safety at risk,” del Rio said. “The American population has seen this up close for almost 3 years, in a way not seen in decades. One of the clear lessons from the pandemic is that America needs more infectious disease physicians to adequately meet the needs of the country.

Earlier this month, the AMA called the new fee schedule ‘damaging’ due to a ‘widespread 4.5% reduction in payment rates’, which includes an 8.5% cut payments for doctors. Part of the reduction includes a previous 3% reduction avoided by Congress last year that will expire in December.

WADA President Jack resneck Jr., MDsaid in a Nov. 1 statement that “it was immediately apparent that Medicare physician payment rates in 2023 not only failed to account for practice cost inflation and COVID-related challenges to practicing sustainability , but also included generalized damage reduction.”

Along with the multitude of clinicians and nurses working directly with patients, the mitigation strategies – from reviewing masking policies to temporary walls and other methods of preventing the spread of SARS-CoV-2 – have been developed. by infectious disease specialists, who have continued to care for patients during the pandemic.

The concern, according to the former outgoing president of the IDSA Daniel P McQuillen, MDdoes not have enough infectious disease clinicians due to salary cuts and hospital funding decisions at a time when the country needs a strong ID workforce.

“It’s no secret that hospitals and medical systems in the United States are driven by the complexity of the surgery they can perform because the payments are so large,” McQuillen said. “And when you look at what it brings to the budget versus what I bring to the budget, the focus goes there. But if you don’t have people doing what I do…then very soon, the collapse will occur for different reasons.

In general, Medicare’s fee payment schedule pays higher reimbursements for specialties that use resources — and the schedule is largely built around resource-based care — according to McQuillen. “Those of us who practice in specialties that don’t have that extra resource that gets paid get paid a lot less,” he said.

In addition to COVID-19, which McQuillen says has essentially added “another full-time job” to the workforce, ID doctors have been busy battling RSV and influenza, as well as recent outbreaks of poliomyelitis and monkeypox.

“Infectious disease physicians improve patient outcomes and reduce health care costs for people with serious infections,” del Rio said. “They protect patients and the general population by preventing, diagnosing and treating infectious diseases.”

Both del Rio and McQuillen said Medicare’s “complicated payment system” devalues ​​doctors who do cognitive work like devising strategies to prevent hospital outbreaks and limit infections.

Additionally, del Rio said about 80% of counties in the United States do not have a single infectious disease physician. Increased reimbursement is key to building a more robust ID workforce, he said, because the cognitive work they do, beyond treating individual patients, helps protect “the population as a whole by preventing, diagnosing and treating infectious diseases”.

Previous data has shown that fewer young doctors are applying for ID training, and experts have said the pay disparity between ID specialists and other specialties is one of the reasons.

Some expected that the “Fauci effect” — a surge of interest during the COVID-19 pandemic in pursuing a career in medicine — might attract more people to the historically underserved specialty of ID.

“Over the past two years, everyone in medicine has spent a lot of time trying to fend off COVID and get it under control. In a lot of these situations, the people doing what I do have had to figure that out,” McQuillen said. “I realize that CMS is in a difficult position to balance all these competing interests, but at the same time I work for a specialty that has helped save lives in recent years and thanks to this I earn less money .”

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