Medical organizations call for congressional action as calendar approaches end of 2024

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Medical advocacy organizations have a lengthy to-do list for Congress before the end of the current legislature, but it’s unclear what items might get crossed off.

The Senate had 15 days in session scheduled this month starting today, while the House of Representatives has a dozen days in session starting Dec. 3, according to their official calendars. It was unclear if that will be enough time – and there will be enough agreement – to approve legislation that advocates hope would affect U.S. health care policy.

Three urgent action items

There are at least three items in urgent need of reform, said Anders Gilberg, senior vice president for government affairs for the Medical Group Management Association (MGMA). He wrote a letter to House and Senate leadership to outline the organization’s priorities for the remainder of 2024.

“As we approach the end of 2024, we write to emphasize the urgent need for Congress to pass legislation regarding three key issues important to medical groups: averting the finalized cut to Medicare payment and providing an inflationary update for 2025, passing prior authorization reform, and extending telehealth flexibilities,” Gilberg’s letter said.

The Medicare conversion factor will drop 2.83% at the start of 2025. “Without stopping the cut and providing this modest update, medical groups will endure an untenable further reduction to physician reimbursement that will compound other financial pressures such as staffing shortages and rising operational costs,” Gilberg said in the letter.

There is legislation to counter it. The Medicare Patient Access and Practice Stabilization Act of 2024 would stop the cut and add a positive update equal to half the Medicare Economic Index (MEI) to the 2025 reimbursement, he wrote.

Even better would be a permanent solution – such as tying physician reimbursement to inflation as measured by the MEI. That proposal is part of the Strengthening Medicare for Patients and Providers Act, currently pending, Gilberg said.

Searching for support – and finding it

There is Senate support for maintaining physician pay. In late November, 41 senators signed a bipartisan letter to Senate leadership urging action on the looming 2.83% cut, and the American Medical Association published a news release about it.

“Persistent instability in the health care sector – due, in part, to consistent payment cuts – impacts the ability of physicians and clinicians to provide the highest quality of care,” the senators’ letter said. “These continued payment cuts undermine the ability of independent clinical practices – especially in rural and underserved areas – to care for their communities. Some practices have limited the number of Medicare patients they see, or the types of services offered.”

AMA noted a bipartisan coalition of 233 House members also signed a “dear colleague” letter calling for the legislative action needed to avoid the physician pay cut.

“With few days left to legislate, the nation’s physicians are asking to make this a priority during the lame duck session,” AMA’s announcement said.

Additional reforms

As for prior authorizations, the Improving Seniors’ Timely Access to Care Act has bipartisan, majority support in the House and Senate. “The recently reintroduced version of the bill should be included in any must-pass legislation before the end of the year to provide much needed reform,” Gilberg’s letter said.

Since the COVID-19 pandemic, telehealth has expanded across the U.S. health care system. But congressional action is needed to continue some telehealth flexibilities that will expire, Gilberg said. Those include removing geographic and originating site restrictions and keeping an expanded list of health care providers for Medicare beneficiaries.

Hospital perspectives

The American Hospital Association (AHA) agreed on the legislative proposals to maintain or increase physician pay and to extend telehealth waivers that grant flexibility to physicians, other health care providers and patients, said AHA President and CEO Richard J. Pollack. AHA also supports the legislation that would reform prior authorizations, he said in his letter outlining AHA’s legislative agenda.

The nation’s hospital leaders also hope Congress will address the Medicaid Disproportionate Share Hospital (DSH) payment reductions, Pollack said. Starting Jan. 1, there will be an $8 billion reduction in DSH payments to hospitals that care for children, the impoverished, the disabled and elderly, he said.

Congress also should continue the Medicare-dependent hospitals and low-volume adjustment programs for rural, geographically isolated and low-volume hospitals serving rural residents, Pollack said. Another priority: The Safety from Violence for Healthcare Employees Act, which would provide federal protections for hospital workers, similar to legal protections for airport and airline workers, he said.

A potential problem: site-neutral payments

Congress should reject site-neutral payment proposals, Pollack said. That is an issue that independent physicians have supported due to differences in reimbursement for treatment at doctors’ offices or hospital outpatient departments (HOPDs).

“Current Medicare payment rates appropriately recognize that there are fundamental differences between patient care delivered in HOPDs compared to other settings,” Pollack wrote. “HOPDs have higher patient safety and quality standards, and, unlike other sites of care, hospitals take important additional steps to ensure drugs are prepared and administered in a safe manner for both patients and providers.”

There are calls for hospitals to be assigned unique identifiers for each HOPD, Pollack said. That is unnecessary and should be rejected by Congress because hospitals already are transparent about where patients receive care. Additional identifiers would be duplicative and burdensome in billing, he said.