August 6, 2024
Health Policy Report – August 6, 2024
Dr. Moshe Chasky Pens Letter in the Washington Post on Site Neutral Payment
On July 27, the Washington Post published a letter to the editor written by Dr. Moshe Chasky, a hematologist-oncologist at Alliance Cancer Specialists. Dr. Chasky’s letter highlighted how the payment disparity between hospital-affiliated providers and independent providers is driving consolidation and incentivizing hospitals to engage in anti-competitive tactics.
“These payment differentials incentivize hospitals to acquire independent practices to boost their revenue,” Dr. Chasky wrote. “The differentials also drive health systems to further expand their market share through anti-competitive tactics. After my practice refused an acquisition attempt from a large health system, my oncology privileges were revoked — leaving me unable to provide care to my own cancer patients when they were admitted to the hospital. Restricting trusted care teams leaves patients confused, frustrated and in the dark. This trend is bad news for everyone — except hospitals.”
The letter to the editor calls on Congress to pass the Lower Costs, More Transparency Act, which would reduce incentives for hospital-based consolidation.
To read Dr. Chasky’s letter to the editor, CLICK HERE.
To read more about The Lower Costs, More Transparency Act, CLICK HERE.
Missouri Cancer Associates – Columbia Holds Site Visit with Representative Mark Alford (R-MO)
On July 1, Missouri Cancer Associates (MCA) hosted Congressman Mark Alford (R-MO-04) at their practice in Columbia, Missouri. During the visit, MCA leaders took Representative Alford on a tour of the pharmacy, infusion suite, wig room, and new radiation vault. MCA discussed the importance of community-based cancer care, the factors driving consolidation of independent cancer practices, and the negative impacts of ongoing physician pay cuts.
In a post on X summarizing the successful visit, Representative Alford said, “[T]he facility still faces challenges, including a 3.4% cut to Medicare reimbursements and cuts to physician pay. There is a bipartisan effort on Capitol Hill to help address these issues. We are so honored to have this facility in Columbia!”
Congressman Alford is in his first term and sits on the House Committee on Agriculture, Small Business, and Armed Services. The Network and MCA look forward to working with Congressman Alford on issues impacting community oncology.
To read more, CLICK HERE.
To see the photos and tour summary from Rep. Mark Alford, CLICK HERE.
The US Oncology Network Submits Comments on 21st Century Cures Initiative
The US Oncology Network submitted comments on Friday, August 2 in response to Representatives Dianna DeGette (D-CO) and Larry Bucshon, M.D. request for information on the 21st Century Cures Initiative. On June 6, Reps. DeGette and Bucshon sent a letter to stakeholders, interest groups, and healthcare advocates requesting information on what Congress could do to bring about the next generation of innovative treatments.
In the comments, The Network highlighted the role community oncology is playing in cancer research and clinical trials and urged Congress to look to the community setting in developing any public-private partnerships. In the comments, The Network also discussed the partnership with the Sarah Cannon Research Institute (SCRI) and discussed issues related to telehealth and coverage for genetic counselor services in Medicare.
The Network looks forward to working with Representatives DeGette and Bucshon, M.D. as they look to implement the next iteration of the 21st Century Cures Initiative.
To read the RFI, CLICK HERE.
To read The Network’s comments, CLICK HERE.
Obama, Trump HHS Secretaries Call for Site Neutral Reform During Paragon Health Institute Event
On July 29, former Department of Health and Human Services (HHS) Secretaries under the Obama and Trump Administrations publicly advocated for the implementation of Medicare site neutral payment reforms to as a method to fund other major policy initiatives. Speaking at a Paragon Health Institute event, Kathleen Sebelius and Alex Azar called for site neutral policies to pass in Congress, potentially as part of a broader legislative package. Proposals to equalize payments for medical services regardless of what setting they are provided in was previously included in both administrations’ budget proposals.
Site neutral policies have the potential to save taxpayers billions of dollars. Specifically, the Committee for a Responsible Federal Budget previously estimated that site neutral payments in the commercial insurance market could: reduce total national health expenditures by $458 billion, reduce commercial premiums by $386 billion and patient cost sharing by $73 billion, and reduce the federal budget deficit by $117 billion.
Despite strong interest from bipartisan lawmakers, insurers, business groups, and patients, site neutral payment reforms have faced resistance from some hospital groups and policymakers who argue that because hospitals have higher operating costs, they should be reimbursed at higher levels.
However, the support for this reform from former HHS chiefs from opposing administrations highlights a rare area of agreement in healthcare policy. As Congress considers reforms, their combined support underscores the potential of site neutral payment reform in addressing healthcare challenges, marking it as a critical consideration for future health policy development.
To read more and watch a video of the event, CLICK HERE.
To read the Committee for a Responsible Federal Budget’s 2023 report on site neutral payments, CLICK HERE.
New White Paper Reveals Need for Medicare Physician Payment Reform, AMA Sends Letter to Congressional Leaders
With physician groups and advocates broadly disappointed by the latest round of proposed cuts to the Medicare Physician Fee Schedule (MPFS), there has been a loud call for reforms to ensure America’s physicians are appropriately reimbursed.
On July 25, the Center for Medical Economics and Innovation at the nonpartisan Pacific Research Institute released a white paper that detailed how artificially low reimbursement rates used by Medicare to contain costs are exacerbating physician shortages and ultimately threatening patient access to quality care.
The report, “Shortchanging Physicians: The mounting costs from Medicare’s effective income controls on doctors,” found that shortages are a common experience in government-run healthcare systems globally and that inadequate doctor compensation is a major driver of this alarming trend. It describes how reimbursement to physicians has seriously lagged behind explosive growth in consumer, producer, and healthcare prices, suggesting that Medicare’s low reimbursement rates bring real income losses for physicians.
To address this growing problem, the white paper’s author, Dr. Wayne Winegarden, recommends tying physician reimbursement rates to a cost index, such as the Medicare Economic Index, to prevent inflation from eroding physician incomes, and reforming the Merit-based Incentive Payment System (MIPS) program, to reduce the costly burdens on providers and incentivize more innovative, patient-driven care.
On July 24, the American Medical Association and 126 other healthcare advocacy groups submitted a letter to Congressional leaders asking them to pass a series of bipartisan reform bills this year to stabilize the Medicare system. Specifically, the letter called on Congress to pass the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would create an annual, permanent inflationary payment update in Medicare that is tied to the Medicare Economic Index. The groups also called for an overhaul of MIPS, modifications to alternative payment models, and budget neutrality reforms to ensure greater stability and predictability to the MPFS.
“The current Medicare Physician Payment System is increasingly unsustainable and the necessary policy reforms can no longer be delayed without severe repercussions for patient access and quality of care,” the letter says. “The foundational component of strengthening the current payment system is refining the Medicare Physician Fee Schedule to accurately reflect the fiscal and clinical realities of medical practice today.”
To read the Pacific Research Institute report, CLICK HERE.
To read the letter from the AMA and other healthcare organizations, CLICK HERE.
To read more about the Strengthening Medicare for Patients and Providers Act, CLICK HERE.
CMS Announces Medicare Premium Changes, Including Part D Payment Demonstration to Ease IRA
On July 29, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Part D bid information for Calendar Year 2025 to help drug plan sponsors finalize their plan offerings and prepare for Medicare open enrollment. Recent key updates to Medicare Part D by CMS highlight changes that the Biden-Harris Administration has made to reduce out-of-pocket prescription drug costs following the passage of the Inflation Reduction Act (IRA).
One of the biggest updates announced by CMS is a $2.08 increase in the base beneficiary premium, a modest bump, which the Administration hopes will ensure affordable choices for Medicare beneficiaries. Next year, out-of-pocket prescription drug costs will be capped at $2,000 and the Medicare Prescription Payment Plan will allow Part D beneficiaries to spread the cost of their prescription drugs over the year. Moreover, CMS is updating how it reimburses drug plans by shifting government payments from reinsurance to upfront risk-adjusted subsidies. The IRA also limits annual premium increases from 2024 to 2029.
CMS also announced a voluntary demonstration program to test if policy changes can stabilize premiums for stand-alone prescription drug plans, thereby offering more predictable options for Medicare Part D beneficiaries and helping sponsors prepare for future bidding. This Part D Premium Stabilization Demonstration also aims to help Medicare Part D enrollees make decisions best suited to their prescription drug needs, in addition to testing if increased premium stabilization and financial protection for stand-alone Part D plan sponsors enhance the efficiency and cost-effectiveness of the Part D program during this transition.
To read more about CMS’ release of preliminary technical Medicare Part D bid information, CLICK HERE.
Lawmakers Express Scrutiny Over Potential New Congressional Regulatory Office Post-Chevron Ruling
On July 23, the Committee on House Administration held a hearing about the end of the Chevron deference doctrine, which previously guided how federal agencies may interpret statutes.
At the recent hearing titled ‘Congress in a Post-Chevron World,’ experts and lawmakers discussed the implications of the termination of the Chevron Defense doctrine, which required courts to accept federal agencies’ reasonable interpretations of unclear statutes. The recent Supreme Court decision in Loper Bright Enterprises v. Raimondo proclaimed that this practice undermines the separation of powers by granting excessive authority to the executive branch while reducing judicial oversight. Witnesses at the hearing included economic and regulatory experts who unanimously argued that Congress needs structural reform to review administrative rules, clearer legislative texts for agency accountability, better use of existing staff for oversight, and increased engagement in the rule-making comment period.
Legislators questioned the specific accountability measures Congress should adopt to ensure that federal agencies adhere to legislative intent in both rule-making duties and enforcement activities. Witnesses argued that Congress should draft laws with specific statutory texts and clearly defined outcomes to limit agency discretion and should proactively engage existing Legislative Branch staff, such as the Congressional Research Service, to make sure federal agencies follow proper legislative intent. Witness Kevin Kosar, a fellow at the American Enterprise Institute, also shared his proposal to create a nonpartisan congressional regulatory office for greater oversight.
To watch the Full Committee Hearing, “Congress in a Post-Chevron World,” CLICK HERE.