I have practiced medicine for 24 years. I have watched patients recover, watched communities grow, and watched colleagues practice with pride in what they built. What I never expected to watch was Medicare pay me less than it costs to keep the lights on.
In 2025, Medicare reimbursed physicians below the direct cost of care for more than 300 office-based interventional procedures. Not below a comfortable margin — below actual cost. Because the supplies and equipment required to perform these procedures safely and effectively cost more than what Medicare reimburses, my practice has had to absorb that difference. No wonder independent physician practices are closing and being bought by hospitals and health systems at an alarming rate.
Meanwhile, in 2025. hospital outpatient departments were paid an average of 124% more by Medicare for those exact same procedures. Not because they deliver better outcomes, but because the Medicare Physician Fee Schedule — the formula that determines what office-based physicians get paid — was built in an era before medical technology had advanced to allow for high-tech medical interventions to be performed safely in the office. Every year the MPFS goes without structural reform, more independent practices close.
The consequences fall hardest on patients. When independent practices close, patients can lose access altogether or be redirected to hospitals where costs are significantly higher and wait-times are longer. In rural and underserved communities, where my practice may be the only option nearby for interventional care, closure is not an inconvenience. It is an access-to-care desert.
Fortunately, HR 7863, the Promoting Fairness for Medicare Providers Act, would establish a new payment pathway that ties reimbursement for high-cost, supply intensive procedures to 90% of the ambulatory surgery center rate — using real, annually updated cost data. It keeps office-based care the lowest-cost option in the Medicare system. It saves taxpayer money. And it gives independent physicians a chance to stay independent. This legislation, led by Reps. Gus Bilirakis, R-Fla., Raul Ruiz, MD, D-Calif., Greg Murphy, MD, R-N.C., and Danny Davis, D-Ill., is bipartisan because the problem is not political — it is structural. Twelve national physician societies also have added their names in support.
I did not go to medical school to become a line item in a hospital’s consolidation strategy. I became a physician to take care of patients in my community, in a setting that is accessible, affordable, and accountable to them. Removing high-cost supplies and equipment from the MPFS, consistent with the goals of HR 7863, would help stabilize my office-based center and help me keep treating my patients in the lowest cost setting for them. Congress should pass this legislation.
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