|
December 2024
In this issue we feature:
Health Policy and Advocacy Recap from the
2024 Annual Meeting
The 2024 Annual Meeting underscored LUGPA’s commitment to preserving and advancing independent urology practices. Discussions at the meeting focused on key policy areas, including physician payment reform, the implementation of MIPS Value Pathways (MVPs), and significant legislative milestones that impact the future of independent healthcare practices.
Over the past year, LUGPA has collaborated with Congress to address systemic challenges associated with MACRA, PTAC, and budget neutrality. A significant achievement was the introduction of bipartisan legislation by the Doctors' Caucus to prevent a 2.8% Medicare payment cut in 2025. Additionally, CMS adopted a phased approach to planned cystoscopy reimbursement cuts, which mitigated the immediate financial impact on office-based procedures.
At the Annual Meeting, MEDPAC Commissioner Dr. Brian Miller of Johns Hopkins University, and former U.S. Speaker Kevin McCarthy shared key insights, emphasizing independent practices' challenges.
Dr. Miller highlighted the adverse effects of healthcare consolidation, focusing on policies such as the Stark Law and the federal ban on physician-owned hospitals. These policies restrict competition and limit patient choice. Dr. Miller advocated for reforms to the physician fee schedule and referral laws to create a more competitive healthcare environment.
Speaker McCarthy emphasized the importance of political engagement, urging LUGPA members to share their personal stories with lawmakers. He identified 2025 as a pivotal year for healthcare reform and encouraged members to act swiftly to advance policies that will support independent practices.
Key Legislative Wins in 2024
LUGPA successfully achieved several legislative milestones this year, including:
- Site-Neutral Payment Reform: The House passed H.R. 5378, which ensures equitable Medicare reimbursement across all care settings and helps eliminate discrepancies in payment based on the site of service.
- Cancer Therapy Access: The introduction of H.R. 5391/S. 2764, which establishes manufacturer rebates to offset the cuts to Part B drug reimbursements, ensuring continued access to essential cancer therapies.
- In-Office Dispensing Protections: The advancement of H.R. 5526 preserves patient access to critical medications dispensed directly in-office, ensuring that patients can continue to access timely and convenient treatments.
As the year comes to a close, LUGPA continues to monitor several key pieces of legislation, including those focused on PBM transparency, cost-sharing caps, prior authorization reforms, and the Medicare Patient Access and Practice Stabilization Act (H.R. 10073). Introduced by Representative Dr. Greg Murphy, H.R. 10073 aims to address the financial pressures faced by independent practices. The bill proposes:
- A 4.73% increase in the 2025 PFS conversion factor.
- Inflationary updates to stabilize Medicare payments and help practices keep pace with rising costs.
LUGPA strongly supports this legislation and encourages members to advocate for its passage to ensure the continued sustainability of independent practices and safeguard patient access to care.
A full recap page is available here.
New LUGPA Congressional Advocacy Efforts
For decades, stagnant Medicare reimbursement rates have failed to keep pace with rising practice costs, placing significant financial strain on independent practices. With CMS's proposed 2.8% reimbursement cut for 2025 and a projected 3.6% increase in practice costs, independent practices face a growing challenge. Without reform, this system will continue to limit access to high-quality care for Medicare beneficiaries, particularly those in rural and underserved areas.
To address this, LUGPA has developed a letter for members to send to Congress, urging immediate action to stabilize Medicare payments. The letter calls for bipartisan solutions to eliminate the proposed 2.8% physician pay cut and introduce annual inflation updates to the Medicare fee schedule based on the Medicare Economic Index (MEI). These reforms are critical to preserving the sustainability of independent practices and ensuring continued access to quality care for Medicare beneficiaries.
LUGPA encourages all members to participate in this advocacy campaign and to contact their congressional representatives to demand action. Together, we can protect Medicare's future and ensure that independent practices continue to deliver exceptional care.
LUGPA Supports Site Neutrality Reform Efforts
LUGPA remains at the forefront of advocating for site-neutral payment reforms. We recently supported a white paper published on October 31 by Senators Bill Cassidy and Maggie Hassan, which includes several key recommendations aligned with LUGPA’s advocacy:
- Expanding site-neutral payments to include all off-campus hospital outpatient departments (HOPDs).
- Strengthening the enforcement of existing site-neutral laws to ensure compliance.
- Revising 340B drug pricing eligibility to exclude hospital-acquired physician practices.
These reforms aim to reduce costs, limit healthcare consolidation, and improve patient access to care across all settings.
Advocacy Update: Progress on the Seniors Access to Critical Medications Act
LUGPA is advocating for Senate action on the Seniors Access to Critical Medications Act, allowing physician practices to safely dispense critical medications directly to patients. The bill passed the House in September but faces late opposition from pharmacy groups. In November, LUGPA’s DC advocacy team addressed their unfounded concerns with several Senate offices, highlighting:
- State Licensure Preserved: The bill doesn’t override state pharmacy laws.
- Enhanced Patient Care: Requires annual visits, exceeding the lack of interaction in PBM-controlled mail-order systems.
- Comprehensive Support: Physician teams coordinate care, monitor side effects, and assist with copay support.
- Proven Safety: No misuse was reported during its widespread use in the Public Health Emergency.
This legislation reduces barriers to patient access to essential medications. Encouraging responses from Senate offices will bolster our efforts to include this critical bill in year-end legislation.
MedPAC Recommends Linking Physician Payments to Inflation
In November, the Medicare Payment Advisory Commission (MedPAC) recommended linking Medicare physician payment updates to inflation through the Medicare Economic Index (MEI). MedPAC proposed adjustments at 50% of MEI or MEI minus 1%. LUGPA strongly supports these recommendations and advocates for comprehensive inflation adjustments, as outlined in H.R. 2474, the Strengthening Medicare for Patients and Providers Act, to ensure independent practices' financial stability and protect patient care access.
DEA and HHS Extend Telemedicine Flexibilities
In November, the DEA and HHS extended telemedicine flexibilities for prescribing Schedule II-V controlled substances through December 31, 2025. This extension ensures continued access to care via telemedicine while policymakers evaluate the long-term role of telemedicine in the healthcare system. However, significant uncertainties remain regarding reimbursement policies for telehealth services, as Congress has yet to extend E&M telehealth coverage beyond 2025 for most services, except for a few specific areas, such as narcotics and mental health. It remains to be seen whether Congress will address this in a lame-duck session.
LUGPA remains committed to advocating for policies that enable independent practices to continue providing exceptional care to patients while adapting to the evolving healthcare landscape. We will continue to update members on key developments and encourage active participation in our advocacy efforts.
Senators Introduce Health Care Cybersecurity
and Resiliency Act
In November, a bipartisan group of senators, including Bill Cassidy (R-LA), Mark Warner (D-VA), John Cornyn (R-TX), and Maggie Hassan (D-NH), introduced the “Health Care Cybersecurity and Resiliency Act.” The bill seeks to strengthen federal coordination on healthcare cybersecurity and provide resources to help smaller hospitals defend against cyber threats.
Key Provisions:
- Federal Grants to improve cybersecurity in health organizations.
- Incident Response Plan for HHS to implement within one year.
- Updated HIPAA Standards for better cybersecurity practices.
- Best Practices for rural health centers.
- Enhanced Coordination between HHS and CISA to address cyberattacks.
LUGPA strongly supports efforts to improve cybersecurity, and this legislation is a crucial step toward better protecting urology practices and patients. While the bill’s future in the current Congress is uncertain, its sponsors plan to advance it in the next session.
For more on improving healthcare cybersecurity, visit LUGPA’s dedicated page: Improving Cybersecurity for Healthcare Providers.
|
