Physicians are increasingly concerned about the negative impacts of declining reimbursement rates on their practices and independence, particularly in a healthcare environment marked by consolidation.
In addition to threatening the survival of their practices, some physicians say that falling reimbursement rates from CMS and private payers are also damaging relationships with patients. A key factor is the lack of transparency between payers and physicians, which subsequently affects communication between physicians and their patients.
"It's almost like there was a very antagonistic relationship when people would [complain] at me, their doctor, about their co-pay for something," Susan Baumgaertel, MD, an internal medicine physician in Seattle, told Becker's. Dr. Baumgaertel practiced at The Polyclinic in Seattle for 25 years, where she also had an ownership stake, before launching her independent telemedicine practice, myMDadvocate.
She frequently encountered patients who expressed frustration about having to pay co-pays in addition to their health insurance premiums. The opacity surrounding how reimbursement rates are set, and the destination of co-payments, often led to friction during billing.
"I said [to patients], this has nothing to do with me. I have no control over the fact you have to pay 20 bucks for this visit. That is between you and your insurance company," Dr. Baumgaertel said. "They looked at me like I was evil. I don't get 20 bucks from your visit. I felt like, if you get a buck, you know, they would look at me."
This dynamic has created a cycle where patients, frustrated by unexpected charges for services believed to be covered under their insurance, direct their dissatisfaction toward physicians. With limited access to the entities setting reimbursement rates, doctors often become the default target for patients' frustrations.
The challenges related to reimbursement were a significant factor in Dr. Baumgaertel's decision to leave her employed role and establish a practice that operates outside of the traditional insurance model. At myMDadvocate, she bills directly for her time, similar to a law firm's hourly billing.
Declining reimbursement rates also force physicians to weigh the financial feasibility of treatment options alongside medical necessity, creating a balancing act that has led some to reconsider the types of patients they accept or to leave medicine entirely.
"This only makes accessing quality physician care more challenging for patients as physicians opt out of Medicare or retire, often out of desperation," Dr. Baumgaertel told Becker's. "At a time when finding a physician is often an impossible task, I find it unconscionable that, year after year, this payment neglect is never addressed."