December 18, 2024
Health Policy Report – December 18, 2024
Dr. Mark Fleming Pens Op-Ed in Medical Economics
In an op-ed recently published in Medical Economics, Dr. Mark Fleming, Chair of The US Oncology Network’s National Policy Board, called on Congress to level the playing field for independent providers.
Citing the critical benefits of community-based cancer care centers that provide cost-effective, high-quality, and accessible treatment options, Dr. Fleming urged lawmakers to advance site-neutral payment reform and long-term Medicare physician payment reform. He emphasized that, if Congress doesn’t level the playing field, patients will continue to see their access to community-based care eroded.
Dr. Fleming also pushed Congress to enact longer-term reforms to physician reimbursement to provide annual adjustments based on inflation and adopt a framework to equalize payment across care settings.
“Unless Congress takes swift action, years of successive Medicare payment cuts and an uneven playing field for independent physicians will undermine access to community cancer care for millions of at-risk cancer patients nationwide,” Dr. Fleming wrote. “It’s up to lawmakers to ensure that this worst-case scenario does not happen.”
To read Dr. Fleming’s op-ed, CLICK HERE.
New Mexico Governor Lujan-Grisham Visits Nexus Health
On November 25, New Mexico Governor Lujan-Grisham visited Nexus Health for a tour of their new multi-specialty practice in Santa Fe. Governor Lujan-Grisham and Nexus Health physicians discussed the importance of providing accessible, high-quality, and affordable community cancer care in the Santa Fe area and throughout the state.
The US Oncology Network and Nexus Health appreciate the Governor’s dedication to ensuring that all patients have access to the community-based care they need. If you are interested in hosting a site visit, please contact Angela.Storseth@usoncology.com.
Congress Moves Ahead on End-of-Year Package
As Congress approaches its government funding deadline on December 20th, lawmakers have released the text of a healthcare package to more tightly regulate business practices for PBMs and ease telehealth rules.
The package includes a proposal to delink PBMs’ Medicare reimbursement from the list price of the drugs, crack down on “spread pricing” in Medicaid, and add transparency requirements for PBMs in the commercial market. Additionally, lawmakers have extended pandemic-era telehealth rules through 2026, allowing Medicare patients to see their doctors virtually.
The proposal includes a 2.5% payment update for physicians under the Medicare physician fee schedule, slightly offsetting the 2.83% cut finalized by the Centers for Medicare & Medicaid Services in November.
Finally, the package includes language similar to the Lower Costs, More Transparency Act, which would require a unique National Provider Identifier (NPI) for Medicare hospital claims. The provision would determine whether care is being delivered in an outpatient setting, helping boost transparency in hospital billing practices.
The continuing resolution (CR) is set to last for three months, expiring on March 14th.
Brett Guthrie (R-KY) Set to Chair the House Energy and Commerce Committee
Representative Brett Guthrie (R-KY) is set to Chair the House Committee on Energy and Commerce, which directs legislation around healthcare issues including Medicare, in the upcoming legislative session.
In his campaign for the leadership role, Guthrie promised his Republican colleagues that he would focus on bolstering oversight over Inflation Reduction Act (IRA) programs, work to streamline drug and medical device supply chains, and reduce drug costs by improving transparency.
Guthrie has stated that expanding the use of Medicare Advantage (MA) plans would provide cheaper, higher-quality care to patients, though he has expressed support for prior authorization reform.
To read more about Rep. Guthrie’s positions on healthcare issues, CLICK HERE.
Lawmakers Plot to Force Health Insurers to Sell Off Pharmacies
On December 11, Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) introduced a Senate bill that would require healthcare companies that own health insurers or PBMs to sell their pharmacy assets within three years. A companion bill was also introduced in the House by Representatives Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN).
“PBMs have manipulated the market to enrich themselves—hiking up drug costs, cheating employers, and driving small pharmacies out of business,” Warren said in a statement. Drugs dispensed via mail-order pharmacies can cost many times what other pharmacies charge. A Federal Trade Commission investigation similarly found that PBMs steer patients away from less-expensive drugs and overcharge for cancer treatments.
The bill’s introduction marks the next step in Congress’s years-long scrutiny on PBMs. It’s unlikely that the bills will be enacted before the end of this year, but its introduction lays the groundwork for further PBM reform next Congress.
To read more, CLICK HERE.
To read the FTC’s report, CLICK HERE.
Senators Bill Cassidy (R-LA) and Maggie Hassan (D-NH) Participate in Site Neutral Panel
On December 11, POLITICO held an hour-long event entitled “Defining Site Neutrality: Navigating Challenges and Exploring Opportunities.” The event featured a conversation with industry experts, along with Senator Bill Cassidy, MD (R-LA), Ranking Member of the Senate HELP Committee, and Senator Maggie Hassan (D-NH).
During the event, lawmakers discussed the history and implementation of site neutral payments, impacts on rural and safety-net hospitals, consolidation, and potential legislative solutions. Senator Hassan (D-NH) emphasized the importance of transparency and fairness in healthcare pricing.
Last month, Senators Cassidy, MD (R-LA) and Hassan (D-NH) released a framwork on site neutral payment reform. Senator Hassan acknowledged that the Cassidy-Hassan legislative framework to implement site neutral payment reform was unlikely to pass in the current Congress, but expressed optimism that it would advance in the 119th Congress. Senator Cassidy, MD (R-LA) who will become Chairman of the Senate Health, Education, Labor, and Pensions Committee in the 119th Congress, emphasized that site-neutral payment reform would remain a priority, though noting it would fall under Senate Finance Committee jurisdiction.
To watch the event, CLICK HERE.
To read more, CLICK HERE.
To read the Cassidy-Hassan framework, CLICK HERE.
Dr. Oz Facing Questions on Medicare Advantage as CMS Nominee
Senate Democrats, led by Senator Elizabeth Warren (D-MA), released a letter calling on Dr. Mehmet Oz, President-elect Trump’s nominee to lead the Centers for Medicare and Medicaid Services (CMS), to answer questions about his past support for broad expansion of Medicare Advantage. Lawmakers pointed out that this platform presents a potential conflict of interest, as Oz owns over $500,000 worth of shares in UnitedHealthcare, the nation’s largest Medicare Advantage insurer.
Oz does not need support from Senate Democrats to secure confirmation as CMS Administrator if he is backed by at least 50 of 53 Republican Senators, but their role in the hearing process could delay his appointment and the implementation of new policies.
To read more about Senate Democrats’ letter to Dr. Oz, CLICK HERE.
To read Dr. Oz’s 2020 op-ed calling for an expansion of Medicare Advantage to the general population, CLICK HERE.
Hospital Billing Practices Won Billions in Extra Payments
According to a new study, hospitals significantly increased the frequency of documenting patients as requiring the highest intensity care, resulting in billions of dollars in additional payments from the Centers for Medicare & Medicaid Services (CMS) and commercial payers.
The study, which examined data from Florida, Kentucky, New York, Washington, and Wisconsin, found a 41% increase in high-intensity coding from 2012 to 2019. Researchers found $14.6 billion in extra payments in 2019 due to upcoding, including $5.8 billion from commercial payers and $4.6 billion from Medicare.
“These findings add to the evidence that hospitals may move patients into the highest billing category in order to increase the amount they are paid for patient care,” said Daniel Crespin, lead author of the study.
To read more, CLICK HERE.