Reforms needed in Medicare Advantage, cybersecurity, congressman says

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Medicare reimbursement for physicians is a pressing issue in Washington, D.C. – but hardly the only problem or policy that lawmakers under consideration there.

Rep. Greg Murphy, MD (R-North Carolina) is the only practicing surgeon in Congress and he is a lead sponsor of the Medicare Patient Access and Practice Stabilization Act. That bill would stop a proposed 2.8% cut to physician pay in the 2025 Medicare Physician Fee Schedule.

Murphy also spoke to Medical Economics about some of the other issues looming large on the U.S. health care landscape. This transcript has been edited for length and clarity.

Medical Economics: Earlier this year, we talked about the popularity and some problems in Medicare Advantage. Would you still support major reform for Medicare Advantage? And what do you think the prospects are for that, long term?

Rep. Greg Murphy, MD (R-North Carolina)

Rep. Greg Murphy, MD: Absolutely would support Medicare Advantage (reform), and it's a program, just like many other programs. Pharmacy benefit managers, for example, started out with a good idea, but then when folks have taken advantage of some of the issues with it, we've seen this with PBMs, with insurance companies, double and triple plucking of dollars. What we're seeing with Medicare Advantage plans are massive, massive distortions from overcoding. So we have one company, it's hundreds of billions of dollars, which, in my opinion, they have stolen from the American people through their costs, through Medicare. It absolutely needs reform, and I think there's very good bipartisan support for it. Truth be told, I'd love us to strike and start new because I think that's the only way we're going to really get hold of this problem. And when you have people like JJ (comedian Jimmie “JJ” Walker), or you have Joe Namath coming out and advertising things, people feel, seniors feel very comfortable with those individuals. Problem is, the devil's in the details, and the details have turned this into a major, major problem for Medicare patients.

Medical Economics: When we spoke earlier this year, the timing was such that we were just beginning to see the effects of the cyberattack on Change Healthcare. After that incident, what reforms would you like to see in cybersecurity in health care?

Rep. Greg Murphy, MD: Well, as a doctor's caucus, we had the vice president in charge of that at UnitedHealthcare come in and talk about what things that they found out, what things that they were doing. They talked about how they would loan money to physician practices to keep them solvent. Only problem with that is, the denial rate with so many of these physician practices, procedures, medications, et cetera, by United and several of the other Medicare Advantage companies, insurance companies, is so high that pulling that money back is going to be a major problem. We need absolute, absolute, really good oversight of what's going on in the cyber world, not only as a nation, but for national security, but also for our technology specifically speaking with medicine. We've seen time and time again where ransoms have to be paid by hospitals or other clinics when someone has gotten into their target rich environment. And I would say this, I think this is absolutely on the radar of every hospital, every clinic, about these things. Not sure how much government can get involved and actually predict that. But this is a major issue on the radar of any health care company or hospital or a hospital system.

Medical Economics: We've seen more and more research emerging about health benefits of the new GLP-1RA antiobesity and antidiabetes medications. There has also been some congressional deliberation about the prices of those drugs. What do you think is the best way to handle both the pricing and insurance coverage for those medicines?

Rep. Greg Murphy, MD: I'll take the drugs as one subject. First, the drugs have shown there are a lot of therapeutic interventions because of the medications, not only with the weight loss, but really sometimes with chronic renal disease, there's some incidences of reports that it decreases malignancy risk. That said, there are side effects. I was actually talking with a surgeon this morning who used to do weight loss surgery. He has set up a separate clinic within his office to do these, to administer these kind of medications and medical therapy. Problem is, they're not without side effect. The problem is also that people gain their weight back when they stop them. And so it's a great thing, I think, that has happened for society. How do we pay for it? is the big thing, and that's really the big conundrum with so much of these new therapies. This was something that found weight loss as a side effect. It's not something that they were looking for in their interventions. And this is a discussion that I think the country has to have as a whole. Everybody wants to attack pharmaceutical companies. Personally, I would love us to get rid of pharmaceutical advertising. I think if we did that, we probably drop drug costs 10, 12%. But the folks in the middle, the pharmacy benefit managers, that most people don't know anything about, are the real thieves that are happening in today's medicine. We need to work on some negotiations and drug pricing coming out of the gate, but once out of the gate and coming through the process, we have middlemen that are stealing so many dollars from the Medicare system and the American patient. That needs absolute reform.

Medical Economics: It's Friday, Nov. 1, as we're talking. On Tuesday, voters are going to pick a new president. Do you want to make any kind of prediction on what may happen on Tuesday?

Rep. Greg Murphy, MD: Well, I think we have two candidates that have a stark contrast in what their vision is for the future of the country. We have the former President Trump, who during his four years was not without controversy. But during those four years, inflation was low, our immigration issues were nonexistent, and national security was pretty much guaranteed. Now we have vice president Harris, who is coming off with a president who's had the lowest numbers ever of a president before. And there are a lot of folks that question her ability actually to lead. They’re different folks, people can attack both candidates for certain things. I do think people are looking at what's happened in the last four years, through the economy, through the migrant issue, and some many other things, and vice president Harris is tagged with whether she was part of that. But I think I give President Trump the edge and winning on Tuesday night.