06/01/2026    Paul Kesselman, DPM

Physician Pay and Ortho Groups Walking Away from Medicare

In the current issue of Becker’s Spine Review
(http://podiatrym.com/go.cfm?n=16152) There is an
story which echoes the comments made over the past
few days regarding physician payment. Several
comments really relate to those comments made
previously. First is that the MIPS program drives
up the costs to medical providers who annually
spend 53 hours on MIP related tasks with
compliance costing physicians almost $13,000 per
year.

My question is how does MIPS or HEDIS or any
similar program actually improve patient care.
Where are the peer review studies to prove it or
are these programs simply a measure by which to
punish physicians and reimburse less? How many
specialty physicians actually measure weight and
height, other than those caring for those issues
and simply rely on patients to provide that
information? Does your Ortho, GI, dermatologist
regularly measure your BP? The list goes on and
on. Do you obtain vital signs or rely on your
patients simply to fulfill MIPS?

The second issue brought up is that physician
reimbursement adjusted for inflation has declined
by 33% since 2001. This while operating costs
continue to increase to be compliant with MIPS,
prior authorization programs, EHR and technology
costs and particularly supply costs, since COVID
and Iran war continue to increase at exponential
rates.

Let’s face it, the system is broken and while many
clamor for a single Medicare for all system, in
its current form, that too would be an abysmal
failure.

You can’t continue to pay 2021 wages to
individuals who have given up 10-15 years of
income, have accumulated half a million or more
dollars in debt and then work at wages totally
incommensurate with their worth.

That recipe will eventually catch up as a brain
drain hits “main stream: medicine. It may not be
happening right now in Medical or Osteopathic
training. But if things continue as they are, the
parents and students of University or High School
students will if they have any sense, see the
handwriting on the wall. I continue to find it
hard to find off spring of health care providers
who wish to emulate their parents, unless they are
independently wealthy and mom or dad are willing
to totally foot the bill If that is the case, we
are not fulfilling an SDH and diverse medical
provider panel.

Our elected officials and health economists must
find a way to take the private insurance companies
out of the health care business. CMS must find a
responsible pathway to cut administrative burden
and pay physicians a fair wage reflective of the
services we provide. As the article states, “If
not, more orthopedic and other specialty groups
will walk out from Medicare.

Not happening in your town? Well it will. As the
article states, “We have seen a lot more
organizations walk away from Medicare patients or
limit the number of patients they see per day
because they just afford it.”

Here in NY a large contingent of physicians from
Hospital for Special Surgery have already dropped
Medicare Advantage Plans as well as fee for
Service Medicare. There are other well-known
hospitals doing the same, not only leaving
Medicare but other plans as well. The handwriting
is on the wall.

More primary care physicians are setting up
concierge medical plans. With little to no
bureaucratic burden, they can make a reasonable
profit as they have fewer employees, regulations,
etc. And more importantly, more time to spend with
their patients.

Perhaps the solution lies in every politician
having the same or similar insurance policies
their constituents have. It is amazing how
accountability would change if the politicians we
elect were subject to exactly the same headaches
faced by their constituents.

Paul Kesselman, DPM, Oceanside NY

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