Recap of LUGPA's July 2024 DC Fly-In

In July 2024, LUGPA convened its second DC Fly-In of the year, where a group of dedicated members gathered in Washington, DC, to advocate for critical healthcare reforms outlined in the 2024 Legislative and Regulatory Agenda.

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This event happened during a politically turbulent time, shaped by significant changes following recent developments in the presidential election and the visit of Israeli Prime Minister Benjamin Netanyahu, which created some challenges. The heightened security and access restrictions meant some meetings had to be moved online.

Despite these hurdles, LUGPA members stayed committed and focused, ensuring their voices were heard in Congress and by key policymakers.

Key Issues Discussed:

Advocacy Efforts: LUGPA focused on advancing key legislative priorities, including:

Seniors Access to Critical Medications Act: Our attendees advocated for H.R. 5526/S. 3458, which enables physician practices to deliver Part D drugs to Medicare beneficiaries' homes. This legislation is crucial for ensuring patients' access to specialized care, education, affordability, and comprehensive care coordination. We highlighted the pivotal role of nurse navigators and in-office staff in assisting patients with medication management and overcoming logistical barriers.
Physician Reimbursement and MACRA Reform: Our members highlighted the need for sustainable physician reimbursement amidst Medicare payment cuts and the bureaucratic burdens of MACRA. The current system, characterized by continued Medicare payment cuts, poses threats such as exacerbating physician shortages and incentivizing practice acquisitions by hospital systems. Our members also underscored the need for fundamental reforms within MACRA to alleviate excessive paperwork burdens while enhancing its effectiveness.
340B Program Reforms: Urged reforms to ensure the 340B program benefits low-income patients and addresses misuse by large hospital systems. The 340B program has grown substantially since its inception, with major nonprofit hospital systems using 340B revenue to purchase competing physician practices rather than serve indigent patients. Additionally, 340B hospitals are not required to show how they are using the revenue and are not required to pass on savings to patients.

During our visits, we recommended regulatory reforms to address these issues, such as implementing transparency requirements to track where 340B drugs are resold and how much providers profit from the program.

Furthermore, LUGPA advocates for strengthening eligibility requirements by mandating a certain level of charity care spending to qualify for 340B discounts, requiring at least 3.8% of the expenditure to be allocated to charitable care.

Site Neutrality: Promoted reforms to ensure equal Medicare reimbursement for services regardless of the setting. Medicare payment disparities favor large hospital systems, leading to consolidation and higher costs. These disparities result in hospital acquisitions that increase prices and limit patient choice.

Site-neutral payments offer a solution by ensuring Medicare reimburses equally for identical services, which can save billions and improve patient care.

The SITE Act addresses these issues with key provisions aimed at ending dishonest billing by prohibiting higher hospital rates for newly acquired doctor's offices, thereby reducing patient costs. Additionally, site-neutral payment reform under the SITE Act ensures equal reimbursement for identical services, which is projected to save taxpayers $140 billion over ten years.

Protecting Patient Access to Cancer Therapies: Supported legislation to preserve physician reimbursement for Part B drugs under threat from the Inflation Reduction Act. The proposed Protecting Patient Access to Complex Therapies Act (H.R. 5391/S. 2764) seeks to address potential reimbursement cuts by replacing them with rebates from pharmaceutical manufacturers to CMS. This initiative aims to balance cost control with ensuring patients' access to life-saving treatments.

Key Priorities:

1. Advancing The Seniors Access to Critical Medications Act (H.R. 5526/S. 3458):

This key piece of legislation advanced out of the Energy and Commerce Committee and is awaiting a House floor vote.
Current CMS regulations prohibit physician practices from delivering Part D drugs to Medicare patients' homes, pushing many providers towards mail-order pharmacies often linked to PBMs under congressional scrutiny.
The act would restore the ability for practices to deliver medications to patients' homes, enhancing affordability, care coordination, and side effect monitoring.
This bill can be included in an end-of-year healthcare reform package.

2. Establishing Sustainable Physician Reimbursement and Reforming MACRA:

We highlighted the unsustainable nature of continued Medicare payment cuts for independent practices.
CMS's proposed 2025 MPFS rule includes a 2.8% decrease in physician reimbursements, exacerbating inflation pressures.
We also stressed the need to tie Medicare reimbursement to increasing practice costs and reforming MACRA to reduce excessive paperwork.

3. Support Reforms to Improve the 340B Program:

Our members advocated for transparency requirements and strengthened eligibility criteria to ensure the program benefits low-income patients.
Voiced our concerns that some large hospital systems have used the 340B program to buy competing practices rather than serve indigent patients.

4. Promote Site Neutrality Reform Efforts:

We addressed Medicare payment disparities favoring large hospital systems, leading to consolidation and higher costs.
Advocated for the Site-based Invoicing and Transparency Enhancement (SITE) Act (S. 1869), which promotes site-neutral payment reforms.

5. Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 5391/S. 2764):

Our attendees emphasized the need to preserve physician reimbursement for Part B drugs amidst cuts imposed by the Inflation Reduction Act.
No action yet; referred to the Energy and Commerce Health Subcommittee.

Meetings and Engagement:

In-Person Meetings:

Rep. Brett Guthrie (R-KY) (Energy and Commerce Committee)
Rep. Blake Moore (R-UT) (Ways and Means Committee)
Rep. Morgan Griffith (R-VA) (Energy and Commerce Committee)
Rep. Brad Wenstrup (R-OH) (Ways and Means Committee)
Rep. Robin Kelly (D-IL) (Energy and Commerce Committee)
Rep. Yadira Caraveo (D-CO) (Energy and Commerce Committee)
Rep. Nicole Malliotakis (R-NY) (Transportation and Infrastructure Committee)
Rep. Raul Ruiz (D-CA) (Energy and Commerce Committee), Scott Hinkle, Chief of Staff

Staff Meetings:

Ways and Means Minority and Majority Staff
Sen. Mike Crapo (R-ID) (Finance Committee)
Sen. J.D. Vance (R-OH) (Banking, Housing, and Urban Affairs Committee)
Sen. Jim Risch (R-ID) (Foreign Relations Committee)
Rep. Mike Carey (R-OH) (Energy and Commerce Committee)
Rep. Darin LaHood (R-IL) (Ways and Means Committee)
Rep. Marc Molinaro (R-NY) (Agriculture Committee)
Rep. Jen Kiggans (R-VA) (Armed Services Committee)
Rep. Lloyd Smucker (R-PA) (Ways and Means Committee)
Sen. Tammy Duckworth (D-IL) (Commerce, Science, and Transportation Committee)
Sen. Sherrod Brown (D-OH) (Finance Committee)
Rep. Brad Schneider (D-IL) (Ways and Means Committee)

Impact and Next Steps:

Legislative Progress: The Seniors Access to Critical Medications Act advanced from the E&C committee and awaits a House floor vote.
Challenges: Addressed ongoing Medicare reimbursement cuts and advocated for reforms essential to maintaining independent physician practices.
Future Considerations: Encouraged co-sponsorship and support for pending legislation crucial to healthcare reform, aiming for inclusion in year-end healthcare packages.

Your Participation Matters!

LUGPA's July DC Fly-In underscored the critical role of advocacy in shaping healthcare policy. Members' active engagement and support were pivotal in advancing reforms that protect patient access and sustain independent medical practices.

We urge all LUGPA members to plan to attend our fly-ins, as your presence is crucial in advocating for healthcare reforms that impact independent medical practices and the patients we serve. We also encourage members of our advocacy donor groups to join us, as your support and insights are invaluable. Your presence and perspectives enrich our advocacy efforts. Together, we can continue to significantly impact healthcare reform and ensure that the voice of independent practices is heard. Join us in bringing about positive change in the healthcare landscape. Those interested in attending a fly-in with LUGPA in Washington, DC, or seeking more information can contact Matthew Glans at [email protected].

With the utmost gratitude, the LUGPA Political Affairs committee wants to thank the physicians and administrators of the following groups whose efforts made the July fly-in possible: