The big issue they have been working on recently is site neutrality, related to how different sites of service can bill Medicare. 

"Clinicians in cardiovascular care are very concerned about any sort of cuts or changes that might reduce the fees that one facility is paid relative to another. There also other initiatives around increasing transparency, which is good for the consumer, but we have to make sure it is done right so it does not cause increased paperwork burden, or frankly so it does not lead to even more confusion," Rosen explained.

He said the majority of elected officials in Congress has no idea how the Medicare payment system works or what is involved to patient care. For this reason, he said it has been very impactful for ASE members, sonographers and cardiologists to come to Washington to speak directly with legislators.

The need for Medicare reform

ASE was among more than 120 medical societies that joined the American Medical Association (AMA) in a letter last fall urging congressional leaders to work with the physician community to enact long-term solutions to the systemic problems related to the Medicare physician payment system. The letter also called on Congress to take action to prevent Medicare payment cuts. There is wide concern across healthcare that as Medicare rates continue to decrease each year, health systems will no longer be able to provide services to Medicare patients because the reimbursements will not cover the costs of other services, or some providers will go out of business trying to do so. 

"This is a perennial issue, and Medicare is one of the biggest payers in the country, so it has a huge impact on ASE members. There are some pretty unfair limitations. I think there is a lot of interest in change, but not a lot of money to do it," Rosen said. 

He expects there will be some movement on Medicare reforms in 2024.

"The other challenge is that Medicare rates just have not kept up with inflation or just the cost of providing services. Physicians across the board have just taken massive cuts, so educating members of Congress is one of the things we do so they understand that the Medicare physician fee schedule really needs some significant updating," Aronson explained. 

She said the Centers for Medicare and Medicaid Services (CMS) is required by current congressional policy to maintain budget neutrality each year. This rule means that, despite rising costs due to inflation and an increasing numbers of patients being added to Medicare each year, CMS must maintain its budget. To do this, CMS reduces its overall reimbursement payments to match what it can pay according to its budget. So as costs and the numbers of exams and procedures increases, fees for all services in Medicare decrease. 

CMS can increase fees paid for some services as an incentive to use services that have better outcomes, help reduce healthcare costs or to help increase the number of physicians working in a specific specialty such as general practitioners. But, this results in cuts elsewhere in CMS reimbursements to maintain budget neutrality. 

Aronson said there was a lot of extra money pumped into healthcare during the pandemic, but the funding was temporary. Providers are now grappling with significant issues with inflation and rapidly increasing staffing costs due to the pre-pandemic shortage of clinicians that was greatly exacerbated by the post-pandemic 'great resignation' of healthcare workers. The continuous fall in reimbursements is factor in why many physicians decided to leave their jobs

On the government side, Rosen said Congress has concerns about the long-term solvency of Medicare. If funding for reimbursements was increased, that money would have to come from other areas of the federal budget. But it has been easier for Congress to cut physician fees paid rather than cut money from federal programs to increase the the Medicare budget.