NASS Insider

May 31, 2022

Advocacy: Instead of Yearly “Fixes,” Let’s Change the Physician Reimbursement System

On April 16, 2015, President Barack Obama signed into law the historic Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), better known as the SGR repeal bill. For those that may not remember, the Sustainable Growth Rate (SGR) formula was a conversion factor that would change the payments for physician services for the next year to ensure that the yearly increase in the expense per Medicare beneficiary did not exceed the growth in GDP.

Because the conversion factor would routinely and drastically adjust down physician reimbursement rates, Congress enacted a “patch” every year to prevent those cuts. At the time of its passing, MACRA prevented a 24.1% cut to Medicare physician payments from going into effect. While MACRA did eliminate the SGR, the threat of yearly payment cuts has only continued. Just this past December, advocacy efforts staved off the majority of a 9.75% cut to the Medicare Physician Fee Schedule. Cuts that were set to take effect while many physicians were still reeling from financial losses due to the drastic decreases in non-COVID-related and non-emergency care.

Because the physician reimbursement rates in Medicare are based on a statutory adjustment factor instead of an inflation proxy – like the Consumer Price Index – when adjusted for inflation, physician reimbursements have declined 20% from 2001 to 2021 while the costs of running a medical practice have increased 39% in that same timespan. It is time this process changes, as fear of yearly cuts to the physician fee schedule creates instability in the workforce, threatens patient access to care, and is a massive time sink for physicians and lawmakers alike.

Thankfully, NASS, and groups like the Alliance of Specialty Medicine and the AMA, are actively advocating Congress make drastic and needed changes to the Medicare physician reimbursement system. Though this will not be an overnight success, and will require that we all reach out to our elected officials – in both the House and the Senate – and urge them to take up this cause.

To learn more about the NASS advocacy efforts, how you can help with our grassroots campaigns, or to support our political giving efforts through SpinePAC please reach out to the NASS Advocacy staff at

Philip L. Schneider, MD
Chair, NASS Advocacy Council