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February 2, 2024
In this issue we feature:
Healthcare Leaders Unite for Reform at LUGPA’s Inaugural Community Practice Summit
In a first-time assembly of medical and health policy experts, the inaugural Community Practice Summit unfolded on January 6, 2024, in Washington, DC. This milestone event was put together and led by LUGPA and was dedicated to establishing novel collaborative efforts to address pressing issues within the healthcare landscape. Representatives from esteemed medical associations—such as the American Urological Association (AUA), US Women's Health Alliance (USWHA), Community Oncology Alliance (COA), Coalition of State Rheumatology Organizations (CSRO), American Medical Association (AMA), and OrthoForum—converged to delineate shared priorities and champion advocacy for impactful reforms.
This unprecedented summit aimed at fostering collaboration among healthcare leaders to address pressing issues within the healthcare landscape. The discussions centered on identifying shared legislative and regulatory priorities, laying the groundwork for a Community Practice Coalition that advocates for impactful reforms. The emphasis on shared priorities and collaborative advocacy signifies a united front in tackling challenges and driving positive change in healthcare.
Congress Fails to Reverse Medicare Physician Payment Cuts
Ongoing negotiations in Congress regarding physician payment cuts have faced challenges, and discussions are intertwined with broader healthcare package considerations. Despite bipartisan acknowledgment of the issue, a resolution remains uncertain. In January, Congress passed another continuing resolution to fund the government for another six weeks, but no new healthcare policy, including legislation to address the 2024 cut, was included. This was disappointing because both House and Senate committees approved legislation to mitigate those cuts substantially last fall. We will continue working with Congress to enact physician payment relief in the March package as Congress wrestles with broader issues.
It's crucial to note that any Congressional relief to these cuts will be temporary and won't fundamentally address the ongoing challenges in Medicare reimbursement or achieve equity between hospital and independent physician reimbursement. LUGPA remains committed to collaborating with policymakers to tackle these issues, advocating for fair reimbursement, and ensuring the sustainability of practices, the U.S. healthcare system, and patient access to care. LUGPA will keep our members informed about upcoming changes from CMS. A package of materials on the MPFS is available here.
MedPAC Recommends Indexing Medicare Base Payment Rate
On January 12, the Medicare Payment Advisory Commission (MedPAC) convened to discuss "Assessing Payment Adequacy and Updating Payments: Physician and Other Health Professional Services." The Commission unanimously approved a draft recommendation for CY2025, emphasizing the importance of updating the Medicare base payment rate and establishing safety-net add-on payments for services delivered to low-income beneficiaries.
The MedPAC draft recommendation for CY2025 focuses on updating the Medicare base payment rate for physicians and other health professional services. The proposed update includes the amount specified in the current law plus 50 percent of the projected Medicare Economic Index (MEI) increase. Additionally, MedPAC recommends enacting safety-net add-on payments for services to low-income beneficiaries, aligning with their March 2023 recommendation.
LUGPA Signs on to Letter Promoting the Safe Step Act
Step therapy, a cost-management strategy employed by healthcare payers, has sparked contention in healthcare policy. While payers argue for its cost control benefits, LUGPA, aligned with providers and advocacy groups, deems step therapy unethical and detrimental to patients, particularly in critical areas like cancer care. LUGPA staunchly opposes step therapy policies and advocates for legislation eliminating barriers to physician prescribing decisions.
Addressing step therapy requires federal intervention, and the bipartisan Safe Step Act aims to amend ERISA, mandating transparent exception processes for medication step therapy protocols within group health plans. Rather than an outright ban, the bill provides specific exemptions, allowing patients to bypass protocols in critical situations. The Act establishes clear timelines for insurers to respond to exemption requests, prioritizing patient well-being.
In January, LUGPA, alongside 110+ patient and provider organizations, joined in an effort to advocate to lawmakers in Congress, calling for comprehensive Pharmacy Benefit Manager (PBM) reform, specifically endorsing the Safe Step Act (S 652/HR 2630). This Act, endorsed by 215+ organizations, is positioned as a patient-centric solution within the broader context of PBM reform.
LUGPA Joins Coalition Effort Endorsing Stark Law Reform
In January, LUGPA signed on to a letter to Congress endorsing the "Seniors’ Access to Critical Medications Act" to address barriers hindering medication access for patients with serious conditions. The initiative aims to rectify Centers for Medicare & Medicaid Services (CMS) restrictions on delivering oral drugs, impacting patient care.
Over the past year, LUGPA has supported the bipartisan bills HR 5526 and S.3458, which clarify that medication delivery to patients or their representatives is not a Stark Law violation. Despite efforts to engage with CMS, legislative action is crucial. These bills, led by Representatives Harshbarger and Wasserman Schultz and Senators Sinema and Blackburn, provide a targeted solution, ensuring patients' access to crucial medications. In the letter, the signatory groups urge Congress to advance these bills promptly, safeguard patients' rights, and uphold quality healthcare delivery.
By joining the coalition effort, LUGPA aligns with the broader mission of ensuring patients' access to crucial medications and advocating for quality healthcare delivery.
LUGPA Signs on to Letter to Congress on Price Transparency for ASCs
In January, LUGPA signed on to a letter to Congress addressing Section 5 of the "Health Care PRICE Transparency Act 2.0" (S. 3548). This section pertains to price transparency requirements for ambulatory surgery centers (ASCs). The letter, signed by various organizations representing ASCs and physicians, expresses concerns about the duplicative nature and potential confusion caused by the provision.
Effective January 1, 2024, health plans must provide comprehensive price comparison information, including in-network rates, out-of-network amounts, negotiated rates, and cost-sharing details. The letter argues that this approach from insurance companies is more effective than the requirements outlined in Section 5 for ASCs.
The letter opposes Section 5 as written, highlighting potential misinformation to consumers and urging policymakers to focus on meaningful changes that enhance healthcare decision-making and access to high-quality care.
CMS Releases New Interoperability and Prior Authorization Final Rule
The release of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) on January 17 marks a crucial step in advancing electronic health information exchange and streamlining prior authorization processes.
The rule applies to various healthcare programs, including Medicare Advantage organizations, Medicaid, and CHIP fee-for-service programs. By mandating the implementation of an HL7 FHIR Prior Authorization API and expanding API requirements, CMS aims to enhance efficiency, transparency, and collaboration in healthcare. This rule reflects a commitment to modernizing healthcare processes and improving patient care through interoperability initiatives.Top of Form
For more information, you can view the final rule here; a Fact Sheet is available here.
Senate Finance Committee Begins Discussions on the Cost of Generic Drugs
The rising cost of prescription drugs, especially generic drugs, has become a key policy point that has generated great interest in Congress during the current legislative session. In January, Senate Finance Committee Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) jointly committed to bipartisan healthcare legislation to prevent and mitigate shortages of critical generic drugs in the United States.
In a recently released white paper, the senators addressed concerns raised by experts during a December 5, 2023, Finance Committee hearing and outlined areas of interest and ideas for addressing drug shortages through modifications to the Medicare and Medicaid programs. Wyden emphasizes the urgency of addressing the generic drug shortage crisis, particularly for cancer patients and those with chronic conditions.
The Committee is exploring legislative developments, including Medicare payment reforms, new incentives for stakeholders to engage in shortage prevention activities, reforms in Medicare Part D, and potential changes to the Medicaid Drug Rebate Program. The senators aim to leverage the power of Medicaid and Medicare to ensure better, more cost-effective healthcare for Americans. More details can be found in the white paper here.
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