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January 2025
In this issue we feature:
Continuing Resolution Avoids Shutdown but Fails to Address Medicare Reimbursement Cuts
The recently passed Continuing Resolution (CR) averted a government shutdown but left critical healthcare reforms unresolved, including a much-needed fix for Medicare physician payment cuts. President Joe Biden signed the CR on December 21, ensuring government operations continue to March 2025, but at the cost of dropping the entire bipartisan health package, which included essential provisions for independent practices and patient care, as well as many other unrelated bipartisan provisions that had been negotiated for months.
Key Points:
- Medicare Cuts Proceed: A 2.8% Medicare payment reduction will take effect on January 1, 2025, equating to a 6.4% real cut when inflation is considered.
- Limited Extensions: Short-term waivers for telehealth and hospital care-at-home programs were included but will expire on March 31, tied to the expiration of the continuing resolution but short of the two-year extension proposed earlier.
- Missed Opportunities: All new health policies that Congress advanced through the committee, including critical reforms such as prior authorization reform, pharmacy benefit manager oversight, and support for value-based care, were excluded from the final legislation.
- Also excluded was the reinstatement of allowances enhancing the ability of our practices to provide in-office dispensing (IOD) services, including the delivery of medications to patients by mail. The House passed this reform in September, and minor adjustments to the bill—without altering its intent—offer hope for bipartisan support to secure its passage by March, when the current continuing resolution expires.
Impact on Independent Practices
Congress’s inaction on physician payment cuts heightens financial strain on independent practices, threatening patient access to care and increasing the risk of practice closures or consolidations.
LUGPA’s Advocacy Priorities
LUGPA continues to push for:
- Immediate adjustments to Medicare reimbursement to address inflation and rising costs and restoration of in-office dispensing that allowed practices to deliver Part D drugs to Medicare beneficiaries’ homes.
- Permanent telehealth extensions and reforms supporting value-based care.
- Bipartisan solutions left out of the CR, such as prior authorization reform and initiatives to improve cancer detection.
We remain committed to collaborating with Congress, our DC team, and advocacy partners to secure the reforms necessary to sustain independent urology practices and ensure quality patient care. Further updates will be shared as we continue these efforts.
LUGPA’s Joins Coalition to Support Reimbursement Parity
In December, LUGPA joined a coalition of stakeholders supporting the Promoting Fairness for Medicare Providers Act (H.R. 10136). This bill seeks to align reimbursements for high-cost surgical procedures in office-based facilities with those in ambulatory surgical centers (ASCs).
Key Provisions:
- Equal Payment for Comparable Services: This policy ensures reimbursement parity for specified high-cost procedures performed in office-based settings and ASCs.
- Patient Cost Protections: Caps patient coinsurance for these procedures at the inpatient hospital deductible amount, reducing out-of-pocket expenses.
- Eligibility for High-Cost Procedures: Defines eligible procedures based on supply costs exceeding a set threshold, with annual updates.
- Regulatory Standards: Establishes health and safety standards for office-based facilities participating in Medicare.
These provisions directly address payment disparities, ensuring fair compensation for independent practices and reducing patient financial burdens.
Support LUGPA’s 2025 Advocacy Efforts
As we prepare for 2025, your engagement and support are more critical than ever. Together, we can:
- Advocate for Medicare payment stability.
- Expand site-neutral payment reforms.
- Push for comprehensive PBM transparency and accountability.
Get Involved:
Your contributions to LUGPA’s advocacy campaigns directly support our mission to protect independent urology practices and ensure patients receive the personalized care they deserve.
For more information or to pledge your support, Please confirm your pledge by January 17 using the pledge card or contact Matthew Glans at [email protected].
Thank you for standing with LUGPA to advance patient-centered, independent urology care. Let’s build on these successes and make 2025 a transformative year for our practices and patients.
PBM Reform: A Growing National Priority
LUGPA has long advocated for reforming pharmacy benefit managers' operations. The newly introduced Patients Before Monopolies (PBM) Act is the latest congressional effort to call for sweeping PBM reforms, including mandatory divestment of PBMs from insurers and enhanced transparency in drug pricing.
Key Provisions of the Bill:
- Divestment Requirement: Insurers must sell their PBM businesses within three years.
- Enforcement: Federal and state agencies can recover revenue from non-compliant entities, redirecting funds to benefit harmed communities.
- Conflict of Interest: Establishes a “firewall” to eliminate conflicts of interest when insurers own PBMs and pharmacies.
Why It Matters:
Independent practices have long faced challenges from PBM practices that inflate drug prices and limit treatment options. This reform is critical to creating a more equitable system that supports patient care and independent providers.
Congress Passes Reforms Limiting Administrative Burden
In December, Congress passed the Paperwork Reduction Act and the Employer Reporting Improvement Act, simplifying ACA reporting requirements:
- Paperwork Reduction Act: Employers must send 1095-B/C forms only upon request, reducing administrative burdens.
- Employer Reporting Improvement Act: Employers now have 90 days to respond to IRS 226-J letters and can submit 1095-B/C forms electronically, ensuring compliance flexibility.
Strengthening Cybersecurity in Health Care
Cybersecurity breaches disrupt care, delay treatments, and create financial strain. The new bipartisan Health Care Cybersecurity and Resiliency Act (HCCRA) of 2024 tackles these challenges by enhancing coordination, updating standards, and offering grants to help providers, especially rural hospitals, improve defenses.
HCCRA focuses on proactive support, requiring best practices like multifactor authentication, encryption, and audits while avoiding punitive measures. The bill aims to protect patient safety and ensure operational resilience by fostering transparency and investing in workforce development.
In addition to the proposed bill, the HHS Office for Civil Rights (OCR) has proposed significant updates to the HIPAA Security Rule, marking its first revision since 2013, to address the healthcare sector's escalating cybersecurity threats.
The proposed rule mandates that health plans, healthcare providers, and their business associates strengthen protections for electronic protected health information (ePHI). It emphasizes adopting modern cybersecurity practices, regularly reviewing and updating security measures, and implementing more explicit safeguards to combat growing threats like ransomware and hacking.
The OCR has reported a 102% increase in large breaches and a staggering 1,002% rise in individuals affected since 2018, highlighting the urgent need for reform. The proposed changes aim to bolster resilience, protect patient data, and restore trust in the healthcare system while aligning with critical infrastructure cybersecurity goals.
A fact sheet on the HIPAA Security Rule NPRM is available here.
For additional resources on enhancing cybersecurity in healthcare, visit LUGPA’s dedicated page: Improving Cybersecurity for Healthcare Providers.
New Dashboard to Advance Patient and Workforce Safety
HHS and the National Action Alliance for Patient and Workforce Safety (NAA) have launched the National Healthcare Safety Dashboard, a centralized tool to track progress toward reducing patient and workforce harm by 50% by 2026.
The dashboard aggregates key safety data from AHRQ and CMS, offering transparency and insights to improve safety in hospital care, with plans to expand to other settings. It empowers providers and policymakers to monitor progress and drive meaningful improvements.
Explore the dashboard here: datatools.ahrq.gov/action-alliance.
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