By Mariah Taylor 

Nearly 20% of people in the U.S. receive health insurance through the Medicare program, but changes in physician fee schedules have made it more difficult for providers to stay in practice, according to a recent March 6.

Here is a brief overview of major changes to the Medicare physician fee schedule in the last 40 years.

Congress introduced the first physician feed schedule in 1989 and the fee schedule was phased into use in 1992.

In 1997, the SGR formula was introduced.

In 2003 and 2004, Congress acted twice to avoid a reduction in fees under the SGR and included two temporary increases to physician payments.

Between 2006 and 2014, Congress acted 15 times to avoid reduction in fees, including three temporary physician pay increases.

In 2015, the Medicare Access and CHIP Reauthorization Act was passed; in 2017, the quality payment program launched; and in 2019, bonus payments for A-APM clinicians began.

In the midst of the pandemic, Congress made four temporary increases to physician payments to avoid reducing fees for years 2021 to 2024. However, in 2023, CMS finalized a 3.4% cut to physician fee schedule conversion factor, which resulted in a 1.25% decrease in overall payments. The changes went into effect Jan. 1, 2024.

Congress is expected to vote on legislation that would mitigate payment reductions temporarily from March 9 to the end of the year, the report said.

Since the 3.4% cut was announced, many physicians have criticized it.

"While we appreciate the challenges Congress confronted when drafting the current 2024 appropriations package, we are extremely disappointed that about half of the 2024 Medicare physician payment cuts will be allowed to continue," Jesse Ehrenfeld, MD, said in a March 6 statement. "There were many opportunities and widespread support to block the 3.37 percent Medicare cuts for physician services that took place Jan. 1, but in the end Congress opted to reverse only 1.68 of the 3.37 percentage payment reduction required by the Medicare Fee Schedule. The need to stop the annual cycle of pay cuts and patches and enact permanent Medicare payment reforms could not be more clear."