Major health policy issues still pending for 'lame duck' congress

Hospitals, physicians and health groups are pushing Congress to address some of their top priorities before the end of the year.

Health systems have extra motivation in the final two months of 2022. A new Congress will convene in January. After the midterm elections next week, there could be new majorities in the House and Senate.

Beyond the question of whether Democrats or Republicans will control Congress, the clock is ticking on some key bills backed by hospitals. Some measures with bipartisan support are close to passage and reaching President Biden’s desk. But if they aren’t passed before the congressional session ends, the bills will have to go through the legislative process all over again.

The time between the elections and the new congressional session is referred to as the “lame duck” period. Hospitals are hoping it can be a productive two months. The American Hospital Association sent a letter to leaders in Congress last week urging them to address several issues.

Here’s a rundown of some key issues of importance to hospitals, health systems and medical groups.

Telehealth

Healthcare advocates are pushing for the extension of telehealth flexibilities. There’s strong support for a bill that would extend telehealth benefits and reimbursements from Medicare through 2024.

The House overwhelmingly passed the bill in the summer, and advocates say there is bipartisan backing in the Senate. But it still must clear the Senate before it can get to the president.

Telehealth usage has soared in the COVID-19 pandemic, but waivers for virtual care are tied to the federal government’s public health emergency. At some point, the Biden administration could phase out the emergency designation.

While lawmakers approved a five-month cushion for telehealth waivers beyond the emergency, health groups want to see at least an extension through 2024.

Ultimately, healthcare advocates, such as the American Telemedicine Association, are seeking permanent telehealth reforms.

Prior authorization

Physicians and health systems are hoping to see passage of a bill that would offer some relief from prior authorization. Doctors and health groups have long complained about the process of securing approval from payers before providing treatment or medication, and they say the process hurts patients and adds to physician burnout.

The House of Representatives passed a bill that would streamline some of the prior authorization process in Medicare Advantage plans, which serve 28 million Americans. It’s dubbed the “Improving Seniors’ Timely Access to Care Act.”

The measure would establish an electronic prior authorization process. Medicare Advantage plans would be required to tell the Centers for Medicare & Medicaid Services how often they are using prior authorization and the rate of approvals and denials.

The Senate has yet to vote on the bill, but advocates note it has more than 40 cosponsors.

Labor shortage

Hospitals have been struggling with labor shortages throughout the COVID-19 pandemic, as some healthcare workers have left health systems or simply got out of the industry. Hospitals are paying higher labor costs, including to staffing agencies, to fill vacancies. The higher labor costs have added to hospitals’ troubled finances, and more than half of all hospital systems could end the year in negative margins.

Some health systems have reduced the number of beds due to staffing shortages, and hospitals say they have been unable to transfer patients due to staffing issues at post-acute care facilities. Hospitals are seeking a temporary per diem payment to cover the costs of caring for those patients.

Hospitals are also pushing for longer-term solutions to address the shortage of physicians. They want Congress to pay for more Medicare-backed graduate medical education slots.

Pay-as-you-go

Hospitals could see cuts in federal aid due to automatic reductions spelled out in federal spending law, unless Congress intervenes.

The Statutory Pay-As-You-Go (PAYGO) sequester requires that mandatory programs don’t add to the federal deficit. Right now, hospitals are slated to see cuts from Medicare.

The American Hospital Association is pushing Congress to block the PAYGO sequester in 2023.

Aid for rural hospitals

Rural hospitals have endured financial challenges for years, and they have been battered in the COVID-19 pandemic. Hospitals are pushing to preserve funding for two Medicare programs that provide $600 million annually to rural hospitals.

Those programs were slated to end Sept. 30, but hospitals secured an extension into mid-December as part of a broader short-term spending plan. Hospitals are urging lawmakers to maintain those programs into the future.

Lawmakers in the House of Representatives have sponsored a bill to extend the programs for five more years. A Senate bill is similar in many respects, but would extend the programs permanently

Hospitals are hoping to sustain the Medicare-dependent Hospital (MDH) program, which aids smaller hospitals with a large share of Medicare patients. There are more than 170 hospitals with this designation. They are also looking to continue Medicare’s Low-Volume Hospital (LVH) designation, which finances rural hospitals with a relatively small portion of Medicare patients. This program supports more than 600 hospitals.

Editor's Note: This news story was first published on our sister publication, Chief Healthcare Executive.