Health Policy Report – May 29, 2024

Texas Oncology Hosts Congresswoman Jasmine Crockett in Dallas

On Tuesday, May 28, Texas Oncology-Methodist Dallas Cancer Center hosted Congresswoman Jasmine Crockett (D-TX) for a site visit to learn more about community cancer care. Rep. Crockett was joined by Dr. Darshan Gandi, Dr. Atisha Manhas, Practice Director Angie Grappe, and several support staff to provide Congresswoman Crockett with a tour of the facility. During the site visit, the discussion focused on the value of community cancer care, site-of-service payment disparities, and the challenges of operating an independent practice today.

Congresswoman Crockett is in her first term in Congress and represents the 30th District of Texas, which includes portions of Dallas and Tarrant counties. She serves on the House Committees on Agriculture and Oversight and Accountability. The Network and Texas Oncology look forward to continuing working with Congresswoman Crockett on issues impacting community oncology. If you are interested in hosting a site visit, please contact Lisa.Langenderfer@usoncology.com or Jasey.Cardenas@usoncology.com.

Dr. Allyson Harroff of Texas Oncology San Antonio Pens LTE in San Marcos Daily Record

Dr. Allyson Harroff of Texas Oncology recently penned a letter to the editor (LTE) in the San Marcos Daily Record that ran on Sunday, May 26, as a follow up to a recent site visit by Rep. Greg Casar (D-TX) to the Texas Oncology San Antonio Downtown practice location. 

Congressman Greg Casar visited Texas Oncology to learn about community oncology care in his district. In Dr. Harroff’s LTE, she emphasized the value of independent practice care and highlighted the disparity in payments between community care and the hospital setting that is causing patients to pay higher costs and travel further. “At independent cancer centers, patients work closely with our patient care teams to personalize their care plan – at a fraction of the cost of care provided in the hospital setting. However, misguided policy has enabled hospital systems to rapidly acquire community cancer clinics, forcing patients to pay more and travel farther for care,” Dr. Harroff wrote.

Dr. Harroff thanked Congressman Casar for taking the time to visit Texas Oncology as The Network looks forward to working with him on issues impacting community care. 

To read Dr. Harroff’s LTE, CLICK HERE.

Bipartisan Bill on Radiation Oncology Reimbursement Introduced in Congress 

On May 15, the Radiation Oncology Case Rate (ROCR) Value-Based Payment Program Act was introduced in Congress with bipartisan support. The bill, introduced by Sen. Thom Tillis (R-NC) and Reps. Brian Fitzpatrick (R-PA), Jimmy Panetta (D-CA), John Joyce, MD (R-PA), and Paul Tonko (D-NY), seeks to shift the way that Medicare pays for radiation therapy and reduce administrative burdens.

If signed into law, the bill would direct the Secretary of Health and Human Services to issue rulemaking establishing a ROCR program in Medicare for radiation oncology practices across the country. The ROCR program would create a site neutral, episode-based payment for 15 common cancer types. The bill aims to provide a more stable and equitable reimbursement structure for radiation oncology services, after more than a decade of cuts to Medicare payments for radiation therapy.

The American Society for Radiation Oncology (ASTRO) expressed strong support for the legislation. “Through ROCR, Congress can build a future where radiation oncology reimbursement is driven by patient needs, not by the number of treatments provided,” Jeff Michalski, MD, chair of ASTRO’s board of directors, said in a press release.

The Network supports the ROCR program to protect patient access to care in the freestanding setting.

To read a press release from the bill’s sponsors, CLICK HERE.

To read a press release from ASTRO, CLICK HERE.

To read more, CLICK HERE.

House Budget Committee Holds Hearing on Consolidation

On May 23, the House Budget Committee held a hearing titled, “Breaking Up Health Care Monopolies: Examining the Budgetary Effects of Health Care Consolidation” to examine increasing healthcare consolidation and emerging policy solutions to reduce healthcare costs and expand patient choice. Lawmakers focused on the many trends that encourage consolidation, including pharmacies, insurance companies that purchase pharmacy benefit managers (PBMs), and hospitals that purchase independent physician offices.

In his opening remarks, Budget Committee Chair Jodey Arrington (R-TX), lead sponsor of the Medicare Patient Access to Cancer Treatment (MPACT) Act, noted that over 700 independent cancer clinics were acquired by hospitals from 2008 to 2020. Rep. Arrington, along with other lawmakers, highlighted the need for site neutral payment reform and applauded the passage of the Lower Costs, More Transparency Act last December.

The hearing featured testimony from experts affiliated with the Congressional Budget Office, American Enterprise Institute, Texas Spine Care Center, and Families USA. The hearing signals a growing concern with the rising costs affiliated with healthcare consolidation and reforms – including site neutral payment – that are needed to address this trend.

To watch the hearing, CLICK HERE.  

Senate Finance Committee Releases White Paper on Physician Payment Reform, House Ways & Means Committee Examines Challenges Facing Independent Medicine

Efforts to address Medicare physician payment and other provider challenges saw bipartisan and bicameral action this week in Congress as the Senate Finance Committee released a white paper on Medicare physician payment reform and the House Ways & Means Subcommittee on Health held a hearing on the challenges Medicare places on independent practices.

Senate Finance Committee Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a white paper proposing significant reforms to modernize Medicare’s physician fee schedule (PFS) and enhance chronic care management. Acknowledging that the current payment system is outdated and inadequate, the policymakers expressed interest in examining ways to make the PFS’s conversion factor (CF) more predictable and refine statutory budget neutrality requirements. The white paper also stressed the value of alternative payment models (APMs), such as the Quality Payment Program’s Advanced APMs (A-APMs), in addressing Medicare physician payment challenges. Senators also suggested changes to the Merit-Based Incentive Payment System (MIPS), which has received criticism over how it reimburses for the value of care. The white paper reflects Senator’s interests, underscoring how they will continue to engage stakeholders as they work through the legislative process on improving physician payment.

Meanwhile, the House Ways and Means Health Subcommittee recently held a hearing titled, “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine,” in which the committee looked to analyze the difficulties independent medical practitioners face, such as financial pressures, regulatory burdens, and competition from larger healthcare systems. Witnesses, including family practitioners, independent physicians, and healthcare administrators, discussed the impact these challenges have on their ability to provide care. The hearing aimed to explore potential policy solutions to support and sustain independent medical practices, ensuring diverse and accessible healthcare options for patients.

To read the Senate Finance Committee white paper, CLICK HERE.

To read the Senate Finance Committee press release on the white paper, CLICK HERE.

To watch the House Ways & Means Subcommittee on Health committee meeting, CLICK HERE.

New Report Shows Employers, Private Payers Pay Significantly More than Medicare for Hospital Services

Private health insurance on average pays hospitals 2.5 times what Medicare does for the same services, according to a recent employer-led study from the RAND Corporation. The study, which used data from privately insured patient medical claims from 2020–2022, revealed that in 2022, employers and private insurers paid hospitals, on average, 254% of what Medicare would have paid for the same care services, a significant increase from the 224% gap recorded in 2020. 

The report also found that there is significant variation by state. Some states – including California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin – had hospital prices that were above 300% of Medicare rates. The report also flags wide ranges of prices within the same market. It also found greater consolidation was correlated with higher prices, with 18% of the variation in hospital prices explained by market share.

To read the study, CLICK HERE.

To read more, CLICK HERE.

FTC Chair Lina Khan Discusses Anti-Trust Enforcement, PBMs Before House Appropriations Committee

On May 15, Federal Trade Commission (FTC) Chair Lina Khan appeared before the House Appropriations Committee to discuss the FTC’s fiscal year 2025 budget request and its ongoing efforts in the healthcare space. Khan touted the agency’s work in blocking anti-competitive mergers and so-called “roll ups” where investors or a larger company make small acquisitions that fall between the FTC’s review threshold but result in a high concentration in one area.

During the hearing, the FTC received bipartisan praise for its investigation into PBMs, which Khan noted have driven up drug prices, impacted small, independent pharmacies, and limited consumer access to affordable medications. Khan highlighted that PBMs, which act as intermediaries between insurers, pharmacies, and drug manufacturers, often engage in practices such as rebate structures, formulary management, and pharmacy network design that can disadvantage smaller pharmacies and inflate medication costs for consumers. Khan emphasized the importance of this probe in ensuring a competitive marketplace that benefits consumers and supports a diverse pharmacy landscape.

Khan also addressed concerns about the FTC’s proposed budget increase of nearly 35%, emphasizing how additional resources will allow the Commission to expand its work in the healthcare space.   

To watch the hearing, CLICK HERE.