Scott Bundy, MD, FACR: Engage Now to Advocate for Sustainable Physician Reimbursement

There has never been a better time to work for sustainable reimbursement for radiologists and all private practice physicians. Over the past two decades, radiologists have sustained repeated reimbursement cuts, yet our practice expenses continue to increase. We need long-term, sustainable reimbursement reform to protect patient access to care.

Scott Bundy, MD, FACR
CEO and Chair, Strategic Radiology
December 10, 2024

As radiologists and other U.S. physicians look down the barrel of the latest 2.8% cut in physician reimbursement, the stakes for engaging in physician advocacy have never been greater.

The latest 2.8% cut can be attributed to a combination of the ongoing budget neutrality guidelines from Congress (mandating that any new coverage decisions be offset by reimbursement cuts since 1989), expiration of a 2% sequestration that previously offset the impact of budget neutrality, and the unresolved PAYGO threat for 2025. The GPCI floor's expiration at the end of 2024 will further exacerbate these challenges.

In response to this year's threat, Strategic Radiology in coordination with the advocacy team Thorn Run Partners has thrown its support behind the bipartisan "Medicare Patient Access and Practice Stabilization Act" (H.R. 10073), which has been introduced to prevent this looming cut and additionally provide a 1.8% payment update in 2025 to help stabilize practices and support quality care for patients.

"There has never been a better time to work for sustainable reimbursement for radiologists and all private practice physicians," said Scott Bundy, MD, FACR, Strategic Radiology CEO and a practicing neuroradiologist with member practice Radiology Associates of North Texas. "Over the past two decades, radiologists have sustained repeated reimbursement cuts, yet our practice expenses continue to increase. We need long-term, sustainable reimbursement reform to protect patient access to care."

Dr. Bundy and Christoper Day, MD, MBA, chair of the SR Advocacy Committee, visited Capitol Hill twice in 2024,along with Shea McCarthy, our representative with TRP, and Linda Wilgus, MBA, former executive director of Northwest Radiology Network and current co-director of RBMA. Collectively, they've worked to impart on lawmakers in Washington the unique role of private practice radiology in the delivery of care nationwide and the issues that impact our ability to serve patients.

"Our main focus is to stop the cuts and get a cost-of-living increase to keep pace with inflation, our longer-term goal," Dr. Day told a recent gathering of Strategic Radiology member in Chicago, during the RSNA.  "We are hammering the legislators, asking them to stop the cuts, and I want to remind you that this is where we need your help: You need to share your stories about what your groups are doing because of these cuts."

Many groups have no recourse but to ask hospitals to subsidize services that were previously provide gratis, such as  night coverage and interventional procedures. Some are forced to drop hospital contracts, and many are unable to grow by adding new contracts, despite the multitude of opportunities that are presenting in this environment.  Small, rural hospitals that provide critical access to health care in their communities are particularly challenged to find radiology service providers for their hospitals 

Reality Check

In his presentation on how the 2024 elections will impact radiology, Ted Burnes, the ACR's RadPACDirector, offered a clear-eyed assessment of the upcoming tussle over funding in Washington. Not much has changed, he reported, even with the House remaining in the hands of Republicans (220 R/215 D) and the Senate now with a Republican margin as well (53R/47D). "In the Senate, if you don't have 60 votes for your party, it doesn't really matter either way," he noted. "Unless it is a budget reconciliation measure, you need 60 votes to pass anything."

Radiology has lost five friends in the House to retirement, but candidates with a health care provider background won 19 of 24 races in the House. Only one physician member of Congress was up for re-election in the Senate and that was John Barrasso (R-WY) who handily won his race. Overall, there are 30 physicians among the 535 members of Congress. "What that means is that 94% of Congress is voting on health care measures that they need to look to their staff to know what they do," Mr. Burnes said. "When you look at how few Members of Congress have health care backgrounds, you can understand why we do what we do. We go to over 300 fundraising events in a calendar year, Congress is in session typically 135 days in a calendar year, so we go to about two fund-raising events a day. It's not glamorous—it's cold eggs, rubber chicken."

There are still legislative days left in the lame-duck session, and Mr. Burnes believes that that not a lot will happen. "If I'm a Republican Congressman in this Congress, and I am going to come back in the next session, I wouldn't do a thing," said Mr. Burnes. "I'd do the bare minimum in the continuing resolution until February/March when Republicans have full control of Congress. If I were a Democratic Congressman, with control of the Senate still, I'd try to get some things through. Because they don't have that 60-vote threshold, it's going to be hard."

Mr. Burnes predicted that not much will happen beyond a continuing resolution that will go to February/March, but he is still hopeful that there will be action on a short-term pay fix for docs so that that physicians do not face a 2.8% cut at the first of the year. 

Reason for Optimism

Either way, Dr. Day urged members to stay engaged and entertain optimism for a sustainable solution. "This battle is not over, and the door is open," said Dr. Day, sharing optimism about the potential to soon achieve a permanent solution that would avoid the need to avert cuts at the end of the year. "We have to keep persisting. We need a permanent fix so that we can stop playing this game at the end of every year."

Echoing that enthusiasm, Mr. McCarthy suggested that a long-term fix may well be within reach — even if notShea McCarthy this year. "Congress devoted considerable resources this year to working on a long-term solution to Medicare physician payment, and we're seeing interest from both sides of the aisle in getting this done.," he shared. "An annual inflationary increase has been the Holy Grail of our advocacy efforts for a long time; heading into 2025, we're starting to see that light at the end of the tunnel."

Dr. Bundy urged all members to respond to every advocacy call-to-action they receive between now and December 20. "If it's from the ACR, the AMA, the subspecialty societies, or any physician organization including Strategic Radiology, please contact your Members of Congress and let them know that this is important," he asked.  If you have not already responded to the SR call-to-action on the Thorn Run Partners grassroots platform, feel free to click this link and weigh in now.

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