Health Care Matters | May 24, 2024
Senate Finance Committee Released White Paper on Physician Payment
On May 17, the Senate Finance Committee released a white paper outlining policy concepts related to reforming the way physicians are paid by Medicare and meeting the needs of those with chronic illness. Topics included payment updates, incentivizing alternative payment models, improving primary care, Medicare quality measurement, and continued access to telehealth.
Why It Matters
The white paper provides insights into areas that are top of mind for the committee and indicates where Congress may be headed as it relates to Medicare payment policy. In the realm of core Medicare FFS physician payment, the committee signals openness to loosening the budget neutrality requirements of annual fee schedule updates to address growing concern about the sustainability of physician reimbursement that does not account for inflation. Not surprisingly, with most of the COVID-era telehealth flexibilities set to expire at the end of this year, the committee expresses its commitment to, “chart a responsible path forward that preserves access to crucial telehealth services.” A significant portion of the white paper is focused on reforming the Merit-based Incentive Payment System (MIPS) and growing participation in alternative payment models. The white paper raises concern about the reporting burden present in MIPS and considers repeal or substantial revision to the program. The committee also acknowledges that the sunset of the Advanced APM bonus may have shifted incentives and seeks approaches to encourage further participation in Advanced APMs. While we don’t know what will ultimately make it into any proposed or final legislation, this bipartisan white paper provides a signal of what may be coming.
Vermont Passes Prior Authorization Reform Bill
On May 20th, Vermont Gov. Phil Scott signed a bill to reform the prior authorization process in the state. As reported by Becker’s, the law requires health insurers to decide prior authorizations within 24 hours for urgent situations and two business days for non-urgent care. Additionally, the law requires the Vermont Department of Financial Regulation to prohibit prior authorization requirements for certain medication and services.
Why It Matters
Vermont’s recent law follows the example of several other states and recently finalized Medicare regulations on the topic of prior authorization reform. The American Medical Association (AMA) reports that nine states and the District of Columbia passed prior authorization reform laws in 2023 with several others contemplating similar approaches. In response to concerns raised by Blue Cross Blue Shield of Vermont that the changes would result in increased spending and subsequent increases in insurance rates, the legislation directs the state to study the effects of the bill on healthcare outcomes, costs, and insurance rates and to include a cost impact analysis of prior authorization laws in other states.
WHAT WE ARE READING
Accountable Care Organization Leader Perspectives
on the MSSP
A qualitative study of priorities and challenges reported by ACO leaders.
What We Are Listening To
NPR: Black Male Caregivers
Black men are a hidden segment of caregivers. It's stressful but rewarding, too.
