KIRKSVILLE, MO -- There’s bad news for Medicare patients and their physicians.

The senate did not repeal the Medicare physician payment formula that reimburses doctors. That means physicians who care for Medicare and Tricare patients will face a 21 percent cut in payment.

“My big concern is if we don't get something resolved, or something more long term, a 21 percent cut in what is already an extremely reduced rate, it's going to affect access to care and when you affect access to care, quality comes right along with that,” said Justin Puckett, D.O.

Puckett says he might be forced to cut back on how many Medicare patients he sees. Otherwise practices like his wouldn't be able to keep the books balanced.

The physician payment went into effect Monday.