Health Policy Report – November 6, 2024

Dr. Moshe Chasky Pens Letter to the Editor on Hospital Consolidation

In response to an op-ed by Laura and John Arnold, Dr. Moshe Chasky, oncologist at Alliance Cancer Specialists, recently penned a letter to the editor in STAT describing his personal experience with site-of-service payment differentials and anti-competitive behavior from hospitals.

“I was shocked when a local hospital revoked my inpatient oncology privileges after my practice refused a merger with their health system. Simply because I preferred to remain in the community setting, I suddenly found myself unable to care for my patients who had been hospitalized. As a result, I am now forced to hand them off to unfamiliar hospital-affiliated providers at a time when patients need an oncologist who has gotten to know them and their condition,” Dr. Chasky described.

Dr. Chasky went on to urge lawmakers to pass site neutral payment reform to ensure independent practices can stay not only operational but competitive. “Doing so would reduce the incentive for hospitals to gobble up physician practices and give patients more power to choose independent care,” he concluded.”

To read more, CLICK HERE.

Texas Oncology Holds Site Visits with State Lawmakers

Texas Oncology recently hosted State Senator Kevin Sparks in Midland and State Representative Dustin Burrows in Lubbock. The visit provided an opportunity for the physicians and practice administrators to share the invaluable role of community oncology in the lawmakers’ respective districts.

During the site visit with State Senator Sparks, Texas Oncology physicians and administrators described how they’re enabling local cancer patients to access affordable, high-quality care – close to home. Senator Sparks’ visit underscored his commitment to understanding and addressing the healthcare needs of his constituents.

In Lubbock, State Representative Dustin Burrows and Texas Oncology physicians engaged in meaningful discussion about the future of community cancer care. State Representative Burrows currently serves as Chair of the House Calendars Committee and plays a crucial role in shaping state legislation.

The US Oncology Network and Texas Oncology look forward to working with State Senator Kevin Sparks and State Representative Dustin Burrows on issues impacting community oncology for patients in Texas. If you are interested in hosting a site visit for your state representative or senator, please contact Angela.Storseth@usoncology.com.

CMS Releases Physician Fee Schedule (PFS) Final Rule

On November 1, the Center for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (PFS) Final Rule for Calendar Year (CY) 2025, which finalized a 2.83% cut to physician payment.

“To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades. For physician practices operating on small margins already, this means it is harder to acquire new equipment, harder to retain staff, harder to take on new Medicare patients, and harder to keep the doors open, particularly in rural and underserved areas,” said Bruce Scott, MD, President of the American Medical Association (AMA), in a statement.

In response to the cut, stakeholders are calling on Congress to advance the bipartisan Medicare Patient Access and Practice Stabilization Act (H.R. 10073), a recently introduced bill that would cancel the 2.8% cut to physician payment and provide a modest, inflation-based update.

“Medical inflation is much higher and the cost of seeing patients continues to rise. Unfortunately, reimbursements continue to decline, putting immense pressure on doctors to retire, close their practices, forgo seeing new Medicare patients, or seek a less efficient employment position. This bipartisan legislation would stop yet another year of reimbursement cuts, give them a slight inflationary adjustment, and protect Medicare for physicians and patients alike,” Representative Greg Murphy (R-NC) about the bill in a statement.

The Network remains committed to working closely with Members of Congress to mitigate this cut to physician payment and protect patient access to care.

To ask your Member of Congress to support legislation addressing Medicare cuts to physician reimbursement, CLICK HERE.

To read a fact sheet, CLICK HERE.

To read more about the PFS Final Rule, CLICK HERE.

To read the AMA’s statement, CLICK HERE.

To read a press release from Rep. Murphy, CLICK HERE.

Senators Bill Cassidy and Maggie Hassan Release Policy Framework for Site Neutral Payment Reform

On November 1, Senators Bill Cassidy, M.D. (R-LA), Ranking Member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Maggie Hassan (D-NH) unveiled a plan to equalize Medicare reimbursements for common outpatient services at hospital-owned offsite locations, ambulatory surgery centers and other clinics. The framework also specifically targets facility fees that hospitals attach for the use of space or equipment.

“As a doctor, my focus is always providing the best care at the most affordable cost,” said Dr. Cassidy in a statement. “If the same care can be safely provided in different settings, patients should not pay hundreds more simply because their doctor works in a hospital. Our framework provides a path to ensure that.”

The framework seeks to lower Medicare spending and hopes to divert savings to hospitals that treat high numbers of low-income patients, are located in rural areas, and offer psychiatry, obstetrics, and other essential services.

The US Oncology Network has signed on in support of the framework, along with stakeholders like the Blue Cross Blue Shield Association, the American Benefits Council, and the Community Oncology Alliance (COA).

“Now more than ever, we must focus on lowering costs to ensure that more patients can access the health care they need. Congress must develop and pass legislation based on this framework because medical costs in large health systems are unsustainable and out of control.  We thank Senators Cassidy and Hassan for their leadership,” COA wrote in a statement.

To read the framework, CLICK HERE.

To read a statement from Senators Cassidy and Hassan, CLICK HERE.

To read COA’s statement, CLICK HERE.

Election Results Begin to Take Shape

Following Election Day on November 5, results have begun to pour in with serious implications for healthcare policy. Former President Donald Trump defeated Vice President Kamala Harris with 277 electoral votes, The Associated Press declared early on November 6.

Healthcare was not a centerpiece of either campaign, but President-elect Trump has expressed his interest in restructuring the Affordable Care Act. Further, health policy experts believe that Biden administration policies to rein in high drug prices – including Medicare drug price negotiations under the Inflation Reduction Act (IRA) – will be on shaky ground in a Trump presidency.

In Congress, Republicans have retaken the Senate after picking up at least three seats in Ohio, West Virginia, and Montana. The size of Republicans’ majority remains up in the air as Senate races in Pennsylvania, Michigan, Wisconsin, Nevada and Arizona remain too close to call. In any case, Senate Republicans will be under new leadership for the first time in 18 years after Senator Mitch McConnell (R-KY) announced that he would step down as Majority Leader. Senators John Thune (R-SD), John Cornyn (R-TX), and John Barrasso, M.D. (R-WY) are in the running to succeed Leader McConnell and have all vowed to work closely with the Trump administration to advance his agenda.

Control of the House of Representatives also remains undecided. It may take multiple days or weeks to finalize results in dozens of races, but it is expected that the party to win the House will do so by a very slim margin once again.

Congress is set to return next week where they will begin their deliberations on leadership and begin discussions on how they will address the lame duck session, with several important measures needing to get done before the end of the year.

To read more, CLICK HERE.

To read more about President-elect Trump’s views on healthcare policy, CLICK HERE.

Oregonians Vote No on Measure 118

Oregonians voted “no” on Ballot Measure 118, which proposed a 3% tax hike on companies with annual sales above $25 million that would have provided eligible residents with tax rebates. According to Oregon Public Broadcasting, nearly 79% of Oregonians voted against the measure, while 21% of Oregonians voted for it.

As Election Day approached, Dr. John Schuler, radiation oncologist at Compass Oncology, sounded the alarm on how this proposal would negatively impact patients’ access to independent cancer care. In an advertisement, Dr. Schuler described how the tax would apply to medical facilities.

“We are the low-cost provider of oncology services in the Portland metro,” Dr. Schuler elaborated in a recent interview. “If we go away, patients will have to drive farther and pay more for care and the cost to the system goes up as well.”

To view the results, CLICK HERE.

To watch the ad, CLICK HERE.

To read Dr. Schuler’s interview, CLICK HERE.

Physician Advocates Express Concern with Proposed MIPS Value Pathways

Physicians are increasingly frustrated with the Centers for Medicare & Medicaid Services (CMS) and its approach to determining reimbursement rates and assessing quality through the Merit-based Incentive Payment System (MIPS). Advocates argue that MIPS, which was originally implemented in 2015, requires time-consuming reporting and strict benchmarks that are unrelated to the quality of care provided. In a poll conducted by the Medical Group Management Association, 70% characterized MIPS reporting requirements as very or extremely burdensome.

In the most recent Physician Fee Schedule (PFS) proposed rule, CMS sought feedback from physicians on whether it should sunset MIPS in 2029 and replace it with a revised version that includes six value pathways. CMS claims that this model is streamlined, but physicians are worried that it will limit their ability to select what quality measures to report.

As such, industry groups such as the AMA, the MGMA, the American Academy of Family Physicians and the American College of Surgeons have called on CMS to forgo phasing out MIPS.

To read more, CLICK HERE.

Community Oncologists Discuss Unintended Consequences of OCM

A recent study led by Dr. Samyukta Mullangi and Dr. Ravi B. Parikh examined the spillover effects of CMS’s Oncology Care Model (OCM) on healthcare costs. They found that the Oncology Care Model (OCM) had significant spillover effects and reduced drug spending for patients on commercial insurance plans.

The study compared costs for commercially insured patients treated at OCM-participating oncology practices with those treated at non-OCM practices, tracking changes in cost, utilization, and quality metrics. Isolating savings in outpatient and infused drug spending, analysis showed significant cost benefits for patients on commercial health plans.

CMS replaced OCM with a modified version, known as the Enhancing Oncology Model, in 2023, which reduced upfront reimbursement payments.

To read more about the study, CLICK HERE.