House of medicine urges congressional action to avert Medicare payment cuts

Wednesday, December 21, 2022 11:34:00 AM

By AAFP’s Federal Advocacy Team

The 2023 Medicare physician fee schedule includes a significant reduction to the Medicare conversion factor, which, absent congressional action, will result in approximately 4.5% in payment cuts for all Part B clinicians beginning January 1. These cuts, coupled with rising practice costs due to inflation and Medicare sequestration, are untenable and will place additional strain on primary care practices. 

Family physicians cannot afford to take a pay cut in 2023, and patients deserve consistent access to high-quality primary care. We are urging Congress to act before the end of year to protect physicians and patient access.

What we’re working on:

Primary care physician groups urge Congress to act on year-end priorities

Why it matters:

AAFP, the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Psychiatric Association, and the American Osteopathic Association, representing more than 590,000 physicians, joined together to urge Congress to take legislative action before the end of the year on critical priorities to that ensure patients have access to high-quality, affordable health care.

What we’re working on:

Along with averting full Medicare payment cuts and streamlining prior authorization, our organizations called on Congress to invest in and support these health care priorities.

  • Medicaid and CHIP are essential sources of coverage for low-income families, including more than half of all children. We called on Congress to enact in end-of-year legislation permanent, nationwide Medicaid and CHIP coverage for 12 months postpartum and 12 months of continuous eligibility for children, to ensure that children and new parents can rely on coverage.
  • The Teaching Health Center GME program has trained more than 1,730 primary care physicians and dentists — 63% of whom are family physicians and are more likely to practice in underserved areas. But without additional funding for the THCGME program, THCs could be at risk of closure. To avoid this, we urged Congress to include a multi-year extension for the THCGME program.
  • Mental health matters, and many patients struggle to access timely mental health treatments, including substance use disorder treatment. In our year-end letter, we asked Congress to help address the mental health and substance use crisis by investing in the integration of behavioral health with primary care.
  • Telehealth has been a lifeline for our physicians throughout COVID-19, but the current short-term extension leaves clinicians and patients in a state of uncertainty. We urged Congress to extend Medicare telehealth flexibilities through 2024.

HHS proposes prior authorization rule

Why it matters:

AAFP applauds the U.S. Department of Health and Human Services for issuing a proposed rule to implement electronic prior authorization standards in Medicare Advantage, Medicaid, CHIP, and qualified health plans on federal exchanges. The AAFP has repeatedly called for streamlined prior authorization to alleviate physician burden and address care delays. 

This rule is a significant step toward reducing the administrative burdens and barriers to care imposed by prior authorization. However, comprehensive reform is needed to standardize, automate, and reduce the volume of prior authorizations and ensure that patients have timely access to care.

What we’re working on:

  • AAFP calls on the Senate to pass the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018) before the end of the year, which would codify electronic prior authorization in Medicare Advantage and improve transparency of prior authorization requirements.
  • AAFP is reviewing the proposed rule and will provide comprehensive comments ahead of the March 15 deadline.
  • Dr. Iroku Malize, AAFP President; Dr. Sterling Ransone, AAFP board chair; and Dr. Steven Furr, AAFP President-elect; wrote in Medscape about their experiences on Capitol Hill urging Congress to streamline prior authorizations for physicians.

AAFP shares recommendations on cybersecurity policies in health care

Why it matters:

The migration to digital health and electronic storage of patient health data has improved the ability for patients to access their health information but has also increased the risk of cyberattacks for all health care organizations. While privacy and security of patient health data is a priority for physician practices, not all of them have the resources, financial capacity, or technical knowledge needed to properly establish and implement best practices in cybersecurity.

What we’re working on:

AAFP shared feedback and policy recommendations to Senator Mark Warner in response to his report Cybersecurity Is Patient Safety: Policy Options in the Health Care Sector. Our letter highlighted ways to strengthen cybersecurity in the health care sector in an attainable and sustainable way for primary care physician practices to protect patient health data.

  • Congress must take action to protect personal and health data outside of the Health Insurance Portability and Accountability Act and ensure that cybersecurity and privacy rules extend beyond the HIPAA regulatory framework.
  • Workforce development programs and student loan forgiveness initiatives should be used to bolster the cybersecurity workforce in the health care sector, especially for small, independent, and rural practices, including those in underserved communities. We provided recommendations of similar programs that may serve as models.
  • Many health care organizations report a lack of in-house expertise, staffing, and collaboration with other entities as barriers to having effective cybersecurity strategies. Congress and HHS must work together to improve the sharing of information, guidance, best practices, and implementation guides on cybersecurity preparedness and cyberattack recovery to physician practices of all types, settings, and sizes.
  • Congress should consider adjusting physician payment methodology to account for cyber expenses and improve regulation of cyber insurance to ensure that smaller health care organizations can afford to implement best practices and can afford coverage.
  • AAFP has also endorsed the Healthcare Cybersecurity Act (H.R. 8806/S. 3904), which would improve information sharing between relevant federal agencies, provide training for health care entities, and evaluate current plans and challenges for implementing best practices — an important first step in addressing health care cybersecurity.

AAFP, ACP, and AAP oppose legislation that disrupts physician-led, team-based care

Why it matters:

AAFP, along with the American Academy of Pediatrics  and the American College of Physicians, sent a joint letter to Congress expressing strong concern with the Equitable Community Access to Pharmacist Services Act (H.R. 7213), which would expand Medicare coverage to permanently include select services provided by a pharmacist.

Physicians work closely with pharmacists and fully appreciate the important role pharmacists play in the delivery of high-quality health care. However, pharmacists should not replace primary care clinicians as patients’ first-contact source of health care. Physician-led, team-based care has a proven track record of success in improving the quality of patient care, reducing costs, and allowing all health care professionals to spend more time with their patients.

Congress must advance policies that grow the primary care workforce, eliminate cost barriers to primary care, and strengthen the medical home.

Family physicians urge everyone, including pregnant patients, to get vaccinated

Why it matters:

Flu activity is surging at alarming rates, and pregnant individuals are at increased risk of severe illness and poor outcomes related to influenza infection. This National Influenza Vaccination Week, AAFP and other health organizations urged health care professionals to strongly recommend flu vaccination to all patients — especially those who are pregnant. Read our call to action here.

Given the anticipated increase in COVID-19 and influenza cases this fall and winter, the AAFP and other health care professional organizations united to remind the public of the importance of vaccinations and early treatment. A strong recommendation from a trusted clinician is one of the most effective strategies to increase vaccine uptake.

For the latest policy updates impacting family medicine, follow us at @aafp_advocacy.

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