The Podcast by KevinMD Medicare cuts are destroying independent rural medical practices
Jan 24, 2026
Jason McKitrick, a healthcare consultant focused on office-based policy, and Saravanan Kasthuri, an interventional radiologist running a rural ambulatory practice, explain why Medicare cuts are crushing independent rural care. They discuss shrinking reimbursements, rising costs, consolidation into hospitals and private equity, and a proposed technical fee schedule as a fix. The conversation highlights threats to access for underserved patients.
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Leaving The System To Keep Clinical Autonomy
- Saravanan left a hospital system to preserve his clinical autonomy and dignity.
- He started an independent office-based practice to avoid hospital mandates and maintain patient-centered care.
Reimbursements Drop While Costs Rise
- Office-based reimbursement has fallen drastically while operating costs and staff wages rose.
- Saravanan reported a 40–45% drop in payment for a procedure alongside much higher staffing and supply costs.
Fee Schedule Subsidizes Hospital Costs
- The Physician Fee Schedule still mixes professional fees with expensive technical supplies.
- Jason explained that hospitals get technical fee reimbursement while physician payments have been diluted subsidizing hospital outpatient fees.