Physician groups to Congress: You failed

Congress failed physicians...again: ©Philip - stock.adobe.com

Congress managed to pass a continuing resolution to keep the government from shutting down over the weekend, but the deal left the 2.83% cuts to Medicare in place, exasperating physician groups that are sounding the alarm about the future of the program.

“The Continuing Resolution utterly fails to address declining reimbursement rates for Medicare, pushing our health system down a path that will have predictable and deleterious results,” said Bruce A. Scott, M.D., president, American Medical Association, in a statement. “For the fifth consecutive year, Congress has adjourned and allowed Medicare cuts. What will be the result? Patients struggling to access health care. Physicians closing or selling their private practices while others opt to leave the profession.”

Congress did not provide a permanent inflation-based update as recommended by the Medicare Payment Advisory Commission nor did it offer a cut reduction. The cost of delivering care is expected to increase 3.5% next year, according to the AMA.

“With this new cut going into effect next year, Medicare payment rates have fallen by 33 percent over the past two decades, when adjusted for the costs of running a practice, leaving physicians struggling to figure out how they can continue to provide needed care to their elderly and chronically ill patients,” said Scott. “Congress also inexplicably missed a golden opportunity to improve patient care by refusing to include prior authorization reform in the final package – a reform with vast bipartisan support in both chambers. Leaving it on the cutting room floor is an unnecessary gift to the insurance industry at the expense of our patients. Physicians have unique training and expertise when prescribing appropriate care, and we don’t need insurance companies delaying and interfering with our patients’ vital treatments.”

The Medical Group Management Assocation’s Anders Gilberg, senior vice president of government affairs, called the resolution a “huge congressional failure.”

“The previously agreed-upon CR, while not perfect, would have critically averted most of the 2.83% cut to physician reimbursement in Medicare beginning January 1,” Gilberg said in a statement. “Now physician practices head into the new year facing uncertainty and financial shortfalls that not only negatively impact the viability of their Medicare business, but their commercial contracts tied to Medicare rates, as well as Medicaid reimbursement in states that use Medicare as a benchmark. Lawmakers are playing a dangerous game that will ultimately hurt patient access to physicians who can no longer deal with the chaos caused by congressional inaction to fix a reimbursement system that continues to destabilize the Medicare program.”

The only area of the resolution that received praise was the short-term extension of the Medicare telehealth flexibilities and the Acute Hospital Care at Home program through March of 2025.

“While this isn’t the outcome we had fully hoped for, the American Telehealth Association and ATA Action are appreciative of this legislation as an important step to avoid disruptions in critical areas of telehealth access,” said Kyle Zebley, senior vice president, public policy, the ATA, and executive director, ATA Action, in a statement. “Looking ahead, we will immediately begin working to ensure Congress makes Medicare telehealth flexibilities and the Acute Hospital Care at Home Program permanent—or secures a much longer extension than 90 days. Simultaneously, we will advocate vigorously to reinstate the vital provisions that were left out of this package."

Several critical telehealth provisions in the original bill were not included in the final year-end funding package:

• First dollar coverage of High Deductible Health Plans – Health Savings Accounts (HDHP-HSA) tax provision
• In-home cardiology rehabilitation flexibilities
• Virtual diabetes prevention program suppliers in Medicare Diabetes Prevention Program (MDPP)
• SPEAK Act which facilitates guidance and access to best practices on providing telehealth services accessibly

“While we are encouraged that the Medicare flexibilities and AHCAH have been given a short-term extension, this is still far from an ideal outcome. We will continue to foster positive and productive collaboration with Congress and the White House, and expect even more work ahead, with heightened urgency, in the coming months with a new administration and Congress to ensure that high-quality patient care is uninterrupted,” Zebley said.