Wide-ranging health care bill would affect physicians

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The Senate Finance Committee said the entire chamber should consider legislation that could bring changes for physicians.

The Committee met for about 90 minutes on Nov. 8, 2023, to discuss the bill titled “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” It involves various aspects of health care, including mental health care access, regulation of pharmacy benefit managers, and Medicare.

Committee Chairman Sen. Ron Wyden (D-Oregon) thanked Ranking Member Sen. Mike Crapo (R-Idaho), their fellow senators and staff for the bipartisan proposals, including 56 amendments suggested.

“I think now we really have a first-rate bill that’s going to send a message for the first time in this $4 trillion health care system that we’ve got in America,” Wyden said, and Crapo agreed in his opening statement.

“This is the way Congress ought to work,” Crapo said. “Today we are taking up common sense, comprehensive proposals championed by members across the dais to strengthen our federal health care program.”

Wyden specifically mentioned Medicare physician payment with the goal to “shore up Medicare’s effort in 2024 to boost payment for primary care.” Lawmakers must reexamine current law, “coming back to this lodestar where we’re spending $4 trillion a year in health care,” but not in the right places, with too much frittered away on middlemen, Wyden said. He added with a national population of about 330 million people, dividing that into $4 trillion, every family of four would get a check for more than $40,000.

A bill for docs

Provisions involving physicians include:

• Amendment 7, the “Resident Physician Shortage Reduction” plan to add 2,000 residency positions a year from 2024 to 2029, through Medicare in qualifying hospitals, including in rural areas and health professional shortage areas.

“Given the considerable time it takes to train a doctor, coupled with the aging physician workforce, the time to invest in training more doctors is now,” said Sen. Robert Menendez (D-New Jersey), the amendment sponsor. He urged the committee to prioritize the nation’s physician shortage.

• Amendment 20 is “Incentivizing Value-Based Care for Providers in Medicare Advanced Payment Models.” Qualifying alternative payment model (APM) participants would get a 3.5% incentive payment for 2026, based on performance year 2024.

Sen. Sheldon Whitehouse (D-Rhode Island) praised the APMs for saving $5.2 billion for Medicare in 2022 and $22.4 billion over the last decade. What’s more, accountable care organizations using APMs guide patients to real health improvements, he said.

“What a remarkable transformation it is when doctors get off the fee-for-service treadmill and deal with patients as real people and have the flexibility to find ways to make them healthier,” he said, offering examples ranging from home health visits to better coordination of pharmaceutical needs.

• Amendment 30 is “To Protect Medicare Physician Payments in Rural States.” The U.S. Centers for Medicare & Medicaid Services (CMS) would improve accuracy of geographic adjustment factors for the Geographic Practice Cost Index under Medicare’s physician payment. CMS would be required to use market data or actual cost data for physician labor.
• Amendment 38 is the “Providing Stability for Physicians and the Medicare Program by Modernizing the Medicare Physician Fee Schedule.” It would update the PFS to mitigate incorrect utilization estimates and ensure accurate cost estimates are used to calculate payment rates.
• Amendment 44 would add the “Improving Seniors’ Timely Access to Care Act,” modernizing the prior authorization process in Medicare Advantage with real-time electronic prior authorizations for routine items and services. There also would be response time requirements for urgently needed care and transparency requirements around prior authorizations.
• Amendment 54 would make permanent reforms to the Medicare PFS to ensure it is aligned with actual costs and utilization for individual services.

Prescription drugs

The legislation has a number of provisions dealing pharmacies, prescription drug prices, and pharmacy benefit managers (PBMs).
Sen. Marsha Blackburn (R-Tennessee) called it “the most significant PBM reform legislation of Congress,” with relief proposed for struggling community pharmacies “that are plagued by cartel-like PBM prices.”

Sen. Ron Johnson (R-Wisconsin) said he was skeptical of the PBM reform measures because PBMs were created as a solution to lower drug costs, and now they are large enough to actually negotiate lower prices. If large pharmaceutical companies favor the PBM reform, there’s something wrong with the PBM reform, he said.

“I think the proof is in the pudding that, to some extent, they're working because Big Pharma is all for the PBM reforms we’re pushing,” Johnson said. He was the lone committee member to decline voting on the bill.