When Medicare policy is debated in Washington, the discussion can quickly become a maze of formulas, percentages and billing rules. But for patients, the question is simpler: Will I be able to get the care I need, when I need it?
That is the question policymakers should keep in mind as they consider changes the Centers for Medicare and Medicaid Services (CMS) has proposed for 2027.
As an orthopaedic surgeon, I see every day how problems involving bones, joints and muscles can affect a person’s ability to live independently. We care for patients with arthritis, fractures, joint injuries, spinal conditions and other musculoskeletal problems that can make it difficult to walk, work or perform everyday activities.
Our goal is to relieve pain, restore mobility and help patients return to the lives they want to lead. For older patients in particular, maintaining mobility can mean maintaining independence.
That is why I am especially concerned about one proposed Medicare change affecting patients who can appropriately be evaluated and treated during the same visit.
Imagine an older Alabamian who drives more than an hour to see an orthopaedic surgeon because of worsening knee pain. After examining the patient, reviewing X-rays and discussing treatment options, the physician determines that an injection could provide relief and can safely be performed that day.
That is what most patients would want: diagnose the problem and, when appropriate, treat it during the same visit.
Under the CMS proposal, Medicare would substantially reduce reimbursement when certain medically necessary evaluations and treatments are provided together. CMS argues there are efficiencies when those services occur during the same appointment. But examining a patient, reviewing diagnostic information, considering treatment options and performing a procedure are not duplicative services simply because they happen on the same day.
Physicians should be encouraged to provide appropriate care as efficiently as possible, but Medicare should not penalize a practice for resolving a patient’s problem in one visit when that is medically appropriate.
This matters especially in Alabama. For someone who lives near the doctor’s office, another appointment may be an inconvenience. For an older patient who lives an hour away, no longer drives and depends on someone else for transportation, avoiding an unnecessary return trip can make a meaningful difference.
This is not just an orthopaedic issue. A dermatologist may evaluate a suspicious skin lesion and determine that a procedure should be performed. Medicare should not make efficient same-day care harder when a problem can safely be addressed during one visit.
These proposed changes also come against a larger backdrop. Medical practices are dealing with rising costs for staff, equipment, technology, supplies and regulatory requirements. Alabama physicians also face a challenging medical liability climate, including the growing threat of exceptionally large “nuclear verdicts.” Those pressures affect more than physicians and practices. They make Alabama less competitive when recruiting doctors and make it harder to sustain care in communities that already have too few physicians. At the same time, Medicare physician reimbursement has declined 33 percent since 2001 when adjusted for inflation.
The concern is not that physicians will stop providing medically necessary care because of a single reimbursement change. Orthopaedic surgeons understand how important Medicare is to the people we serve, and most physicians remain committed to caring for Medicare patients. But it is unrealistic to assume practices can absorb reductions year after year without consequences.
If this trajectory continues – and these latest proposed cuts suggest they might – there will soon come a day when more practices limit the number of Medicare patients they accept, stop offering certain services or leave the Medicare program altogether.
Fortunately, there is still time to change course. The proposed CMS rule is not final, and the agency is accepting public comments through September 14. I also urge every member of Alabama’s congressional delegation to contact CMS and ask the agency to address these concerns before the rule is finalized.
Congress also has another opportunity to protect patient access. The temporary 2.5 percent Medicare increase it approved for physicians this year expires at the end of December. Without congressional action, physicians across specialties will begin 2027 without that support. Alabama’s congressional delegation should work to prevent another reduction while also pursuing a long-term Medicare physician reimbursement system that keeps pace with the cost of maintaining access to care.
For patients, especially seniors and those in rural communities, the goal should be straightforward: fewer barriers, fewer unnecessary trips to the doctor and better access to the physicians they need.
Dr. Zane B. Hyde is a sports medicine and orthopaedic surgeon in Birmingham and president of the Alabama Orthopaedic Society.
