Medicare cuts: ‘It is crucially important we stay engaged in the process’


Society for Vascular Surgery (SVS) members deemed payment and reimbursement among the top advocacy priorities for 2022. A session Wednesday at VAM informed attendees about Medicare payment issues and relayed information on the past, what’s going on in the present and how members can impact the future. 

Matthew Sideman, MD, chair of the SVS Advocacy Council, kicked off the session, hosted by the Government Relations Committee, by briefly reviewing the process of the legislative and regulatory processes. 

While laws are in discussion, vascular surgeons have many chances to impact what those laws look like. “It’s crucially important we stay engaged in the process.” 

Surgeons fought the Medicare Sustainable Growth Rate (SGR) for 15 years. Its replacement, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, hasn’t provided its planned financial stability. “Many in Washington, D.C. view it as a failed policy” 

Current advocacy efforts are focused not only on replacing MACRA but also on shorter-term issues on important legislation, including prior authorization. 

Megan Tracci, MD, Advocacy Council vice chair, explained why Medicare payments are still going down. 

Seventeen SGR patches over 12 years cost more than $169 billion, to no good effect. SGR was then replaced by MACRA; results have been mixed and MACRA has meant vascular surgeons losing ground in every single year” since its passage. 

“Our conversion factor is essentially the same as it was in 1998,” said Tracci. “Physicians have “been tightening our belt for 25 years and aren’t really the problem, she said. Medicare spending has continued to grow, but its distributions have shifted. “It’s now $787 billion, and we’re down to 9 % of that. We’re not going to save our way out of the U.S. government on healthcare.” 

With the funding trend unsustainable, she said, “We need to drive change.” Fixing the payment model and fixing funding must go hand-in-hand, she said. “Advocacy must be data-driven, and we have to bring our data to the table.” 

“We are one vascular surgery team,” emphasized Sean Lyden, MD, committee chair, who discussed recent committee efforts to impact change. “We represent all portions of vascular surgery (in all settings) and represent everybody equally.” 

He stressed the necessity to donate to the SVS Political Action Committee, which currently receives donations from only 7% of SVS members. “If government doesn’t feel like we’re a big voice, they don’t care,” he said. 

“Government relations is about building relationships and getting in front of lawmakers. This requires money, he said. It also means continued reaching out to lawmakers and vital grassroots advocacy. 

Despite some legislative success, such as mitigating proposed payment cuts, battles remain on the horizon, said Lyden. These include the 2023 Medicare Physician Fee Schedule proposed rule and identifying system payment reform options.


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