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The rural health initiative will fail like many government programs that do not address the root cause of the problem. The root cause is the Budget Neutrality limit on physician reimbursement which essentially dictates that as spending on phyisican fees increase there has to be a equal decrease in what the fees are. CMS continues to cut physisian fees over all to comply with this congressional mandate. While they are primarily cutting surgeons and specialists now, the fees for primary care have already been too low to maintain independent practices, and now they will force out of business all the remaining specialists and surgeons. Rural areas depend on small independent physician practices to not only supply care to people but to staff and keep rural hospitals full. Hospitals have been subsidizing physicians when they employ them as the reimbursement is to low to maintain independent physicians even in the hospital systems. Rural hospitals can no longer support these physicians. This is why we are loosing OB services across the state in rural areas – becasue small practices cannot make ends meet. This is why even in urban areas it is nearly impossible to see a primary care doctors untless they are on some cash only type practice or employed by a hospital. Even the hospital employeed primary care doctors are getting hard to see and patients are being shunted to NPs and PAs who are paid less as they have less experience. The CPI has increase 26.6% since 2020 and there have been little or no increase to physician reimbursement. Simple math for any business, as your labor, supply, and rent costs go up you have to charge more or you go out of business at some point. The” rich doctor” is few and far between dispite the common concept on that they made their money a few decades ago). Happy to discuss further. I am a trustee for an association health plan, have been in private practice for a few decades, and manage a practice and surgery center. I see this from multiple view points including being a business owner.
Francis W. Price, Jr MD
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