Health Policy Report – October 31, 2023

The US Oncology Network Hosts Fly-In

On Thursday, October 19th, The US Oncology Network physicians met with key lawmakers in Washington, D.C., including members of the House Energy & Commerce, Ways & Means, and Education & the Workforce Committees, to advocate on behalf of community oncology. Specifically, Network advocates met with House Energy & Commerce Health Subcommittee Chairman Brett Guthrie (R-KY), Reps. Jodey Arrington (R-TX), Michael Burgess, MD (R-TX), Tony Cardenas (D-CA), Buddy Carter (R-GA), Neal Dunn, MD (R-FL), John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), Frank Mrvan (D-IN), and Brad Wenstrup, DPM (R-OH).

Network advocates, including Drs. Les Busby (RMCC), Moshe Chasky (ACS), Andrew Cohen (CCCN), David Drosick (OHC), Kashif Firozvi (MOH), David Hakimian (ICS), Brian Heller (SCC), Rich Ingram (SO), Scott Kruger (VOA), Rupesh Parikh (CCCN), Sucharu Prakash (TxO), and Lisa Santwer (CCCN), discussed key policies related to Medicare reimbursement, including site neutral payment reform.

During the meetings, Network advocates explained how higher reimbursement for outpatient cancer services provided by hospital outpatient departments (HOPDs) is incentivizing consolidation and increasing costs for cancer patients. The group urged the legislators to co-sponsor H.R. 4473, The Medicare Patient Access to Cancer Treatment (MPACT) Act, which would implement site neutral payments for cancer care services and ensure that all patients can benefit from lower costs. The advocates also noted how pharmacy benefit managers and reimbursement cuts limit patients’ access to affordable cancer care in the community setting.

The fly-in ended with a keynote address from Budget Committee Chairman Jodey Arrington (R-TX), the lead sponsor of the MPACT Act, on the importance of site neutral payments to support community-based cancer care. 

To read more, CLICK HERE.

To read a recap of the fly-in from POLITICO Influence, CLICK HERE. 

Dr. Debra Patt Testifies at House Energy and Commerce Health Subcommittee Hearing

In a recent Energy and Commerce Health Subcommittee hearing, Dr. Debra Patt, MD, PhD, MBA, Texas Oncology, testified on the challenges facing independent physicians, including lagging Medicare reimbursement rates, a widening gap between independent physician and hospital reimbursement, and limited participation in value-based care models.

In her testimony, Dr. Patt noted that continued cuts to the Medicare fee schedule, along with rising medical inflation, threaten the financial viability of independently owned practices. Specifically, Dr. Patt highlighted how insufficient payments are driving physicians out of the profession, contributing to workforce shortages and forcing some practices to close their doors. To address this issue, Dr. Patt urged lawmakers to protect physicians from Medicare cuts through the discussion draft of the proposed Provider Reimbursement Stability Act of 2023, which would establish a more appropriate reimbursement system.

Further, Dr. Patt discussed how the Medicare Access and CHIPS Reauthorization (MACRA) program includes excessive and duplicative reporting requirements, adding administrative strain on already-burdened physician practices. However, Dr. Patt did praise the Oncology Care Model, citing the $134 million saved by Medicare over nine performance periods.

Dr. Patt went on to discuss medication access issues facing patients today, noting how CMS has limited at-home delivery of oral cancer drugs post-pandemic. She also noted how pharmacy benefit managers (PBMs) intervene in patient care, highlighting a personal experience with PBMs in which they failed to quickly reduce medication dosages for an expensive cancer drug, leading to medical waste.

To reduce regulatory burden for physicians and ensure better care for patients, Dr. Patt called on lawmakers to pass site neutral legislation, address abuses by insurers and pharmacy benefit managers (PBMs) and increase stability in the Physician Fee Schedule.

To read Dr. Patt’s written testimony, CLICK HERE.

To watch the hearing, CLICK HERE.

To read the Provider Reimbursement Stability Act of 2023, CLICK HERE.

The Network Meets with New Mexico Lawmakers; Highlights Value of Community Cancer Care

The US Oncology Network’s government relations team and Nexus Health recently met with state lawmakers in Albuquerque, New Mexico to emphasize the importance of community care and the accessible health care options offered at Nexus’s new multi-specialty clinic. The new clinic spans a variety of specialties including oncology, orthopedics, hematology, breast surgery, and soon dermatology. 

Nexus Health recently broke away from the hospital system to bring care closer to patients. However, the practice has recently experienced unique pressures from a local hospital, threatening patients’ access to community care. 

During the two-day visit with 11 state lawmakers and key stakeholders, Nexus Health and the Network advocated for a long-term strategy to ensure that the practice can continue to champion accessible, cost-effective health care for New Mexicans.

To read a recap, CLICK HERE.

To read an op-ed on Nexus Health’s decision to step away from the hospital setting, CLICK HERE.

Rep. Mike Johnson (R-LA) Elected as Speaker of the House

On Wednesday, October 25th, The U.S. House of Representatives elected Mike Johnson (R-LA) as the 56th Speaker of the House, ending a turbulent three-week vacancy. The 220-209 party-line vote elevated Johnson to the seat that has been vacant since Kevin McCarthy (R-CA) was removed as speaker on October 3. 

Johnson was the fourth lawmaker to be nominated for speaker by Republicans. After Majority Leader Steve Scalise (R-LA) withdrew his nomination for speaker, Republicans selected Rep. Jim Jordan (R-OH) as the second nominee. However, after three rounds of House floor votes, Jordan failed to secure the 217 votes needed to ascend to the speakership. 

On October 23, Republicans gathered for the third time to select a nominee, choosing Rep. Tom Emmer (R-MN). However, just hours later, Emmer told his fellow Republicans that he was dropping his candidacy for speaker, leaving Republicans to nominate Mike Johnson, who ultimately earned the backing of all GOP lawmakers present in a floor vote. 

Rep. Johnson was elected to Congress in 2016 and served as Chairman of the Republican Study Committee (RSC) from 2019-2021. On health care, Rep. Johnson has been vocal in his opposition to the Affordable Care Act (ACA) and the Inflation Reduction Act (IRA). Notably, during Johnson’s RSC chairmanship, the RSC budget included a provision to implement site neutral payments throughout the Medicare payment system. 

As Johnson assumes the speakership, he’s set to contend with a continued struggle over government funding as the current continuing resolution (CR) is set to expire on November 17. 

To read more, CLICK HERE.

To read more about Johnson’s health policy positions, CLICK HERE.

To read the RSC budget, CLICK HERE.

Senate HELP Committee Advances NIH Nominee

The Senate Health, Education, Labor, and Pensions (HELP) Committee on Wednesday, October 25th, advanced the nomination of Monica Bertagnolli to lead the National Institutes of Health (NIH) by a vote of 15-6. 

The position of NIH Director has been vacant for almost two years and in recent months, HELP Committee Chairman Bernie Sanders (I-VT) has used Bertagnolli’s nomination to highlight his concerns that the Biden administration has not done enough to lower the cost of prescription drugs. 

After a months-long delay, the HELP Committee held a hearing on October 18, in which Sanders remained focused on drug prices, while other senators asked Bertagnolli how she would lead the agency’s activities on maternal health, diabetes, opioid addiction, and mental health crises. 

The HELP Committee advanced Bertagnolli by a vote of 15-6, with Chairman Sanders joining 5 Republicans in opposing her nomination. “Dr. Monica Bertagnolli is an intelligent and caring person, but has not convinced me that she is prepared to take on the greed and power of the drug companies and health care industry,” Sanders said in a statement. 

Bertagnolli’s nomination is now set to move to a full Senate vote. 

To read a statement from Sen. Sanders, CLICK HERE. 

To read more, CLICK HERE.

Healthcare Organizations Call on Congress to Extend Alternative Payment Model Incentives

630 healthcare organizations have recently called on Congress to extend Medicare’s advanced alternative payment model (APM) incentives as lawmakers head into year-end discussions.

Specifically, the group is urging lawmakers to advance the Value in Health Care Act introduced earlier this year. If passed, the bill would implement a two-year extension of MACRA’s original 5% advanced APM incentives and place a freeze on the 50% revenue threshold needed by physicians in value-based care models in order to qualify for bonuses.

These proposed policies would grant HHS flexibility to adjust the financial risk at a pace that enables more physicians to participate in APMs and expand value-based care. “APMs have demonstrated that when physicians and other clinicians are held accountable for costs and quality and provided flexibility from fee-for-service (FFS) constraints, they can generate savings for taxpayers and improve beneficiary care,” the groups wrote in the letter.

The provider groups noted that letting the 5% incentive payment lapse would cause some providers to fall back on the Merit-based Incentive Payment System (MIPS), which they say is burdensome and costly. The letter urged lawmakers to include at least parts of the legislation in an end-of-year package.

To read the bill, CLICK HERE.

To read more from the AMA, CLICK HERE.

Genetic Counselor Awareness Day is November 9, Ask your Member of Congress to Support the Access to Genetic Counselor Services Act

Genetic Counselor Awareness Day is November 9, consider raising awareness about genetic counselors by contacting your Member of Congress to support H.R. 3876/S.2323 the Access to Genetic Counselor Services Act. This bill, introduced by Representatives Adrian Smith (R-NE) and Brian Higgins (D-NY), will improve access to genetic counseling by recognizing genetic counselors as healthcare providers under Medicare and allowing for reimbursement.  

To learn more about this bill and to ask your Member of Congress to cosponsor, CLICK HERE.

To learn more about Genetic Counselor Awareness Day, CLICK HERE.