Integrated Practices | Comprehensive Care

June 2024   

In this issue we feature: 

LUGPA Board Member Testified in Congress on Hospital Consolidation

On May 23, Dr. Timothy Richardson testified before the Ways & Means Health Subcommittee, addressing critical challenges independent physician practices face due to hospital acquisitions and consolidations. He outlined key issues and proposed solutions to mitigate these challenges.

Key Challenges:

  1. Hospital Acquisition of Physicians: Hospital acquisitions of private practices lead to higher healthcare costs and reduced patient choice by eliminating competition and driving care to the more expensive setting.
  2. Unbalanced Reimbursement Schemes: Current reimbursement policies favor hospital settings, financially straining independent practices.
  3. Regulatory Burdens: Laws like MACRA and the Stark Self-Referral Law impose significant administrative and financial challenges.
  4. Inadequate Charity Care: Many tax-exempt hospitals do not provide sufficient charity care despite tax benefits and federal support.

Proposed Solutions:

  1. Predictable and Sustainable Payment Updates: Ensure independent physicians receive payment updates reflecting practice costs to maintain financial viability.
  2. Site-Neutral Payment Policies: Promote competition and patient choice, achieving substantial Medicare savings with bipartisan support.
  3. Reforming MACRA: Enable independent practices to participate in Alternative Payment Models (APMs) and eliminate the burdensome MIPS reporting system.
  4. Simplifying the Stark Self-Referral Law: Modernize the law to encourage innovative, value-based care arrangements without legal repercussions.

During the hearing, there was bipartisan support to address the challenges of independent practices, including provider consolidation, lack of predictable fee updates, staffing issues, and regulatory burdens. Solutions discussed included implementing site-neutral payments, allowing hospital-physician ownership, restructuring MACRA, potentially terminating MIPS, and reforming prior authorization in Medicare Advantage.

A full memo on the hearing can be found here. Dr. Richardson’s testimony is linked here; a video version can be found here.


Second Community Practice Summit Held in Washington, DC

On May 11, the Second Community Practice Summit took place in Washington, DC, uniting a diverse group of healthcare stakeholders, including providers, industry leaders, and advocates. This event provided a platform for in-depth discussions on critical issues related to access and delivery of care in community and independent practice settings.

Key Initiatives Addressed:

  1. In-Office-Dispensing (IOD) Reform: Participants discussed the challenges posed by the current FAQ (SB 3458/5526), focusing on its impact on patient care and access, particularly in underserved rural regions.
  2. Medicare Physician Fee Schedule (MPFS) Reform: Discussions highlighted transparency measures and site neutrality to address reimbursement issues, with concerns about waste within the 340B program and its effects on hospital consolidation and the independent provider market.
  3. Prescription Drug Affordability Boards (PDABs): Attendees examined transparency in drug pricing determinations and their impact on provider reimbursement, voicing concerns about the opacity within PDAB processes.
  4. Graduate Medical Education (GME): Focus was on workforce expansion, rural care incentives, and strategies to combat specialty shortages, including the role of Advanced Practice Providers (APPs) and initiatives to mitigate physician migration and burnout.
  5. Safe Step Act & Prior Authorization Reform: The high costs incurred by providers due to prior authorization were highlighted, underscoring the need for reform to ensure equitable benefits for providers and patients.

Moving forward, the coalition committed to prioritizing coalition building, patient advocacy, and data collection efforts to showcase the efficacy of private practices. There was a shared resolve to address physician fee schedule cuts and strengthen the sustainability and vitality of community practices.


LUGPA Advocacy on AI Concerns in Healthcare 

In May, LUGPA responded to Representative Ami Bera’s request for information by submitting comprehensive comments on integrating artificial intelligence (AI) technologies within healthcare systems. In the comments, LUGPA emphasized three key pillars: clinical efficacy, transparency, and ethical development. The submission underscored the need for AI-driven solutions to undergo rigorous validation, enhance transparency in AI algorithms, and prioritize ethical development to align with the highest standards of medical ethics and professionalism.


Seniors’ Timely Access to Care Act Reintroduced

In May, LUGPA welcomed the bipartisan reintroduction of the Improving Seniors’ Timely Access to Care Act by signing a letter supporting the bill. This legislation aims to streamline care delivery and enhance patient access for seniors by addressing burdensome prior authorization requirements. LUGPA's advocacy efforts played a pivotal role in championing this critical legislation, which seeks to improve healthcare outcomes for seniors.


LUGPA’s Input on CMS’s RFI on Medicare Advantage Data  

In May, LUGPA responded to CMS’s Request for Information on Medicare Advantage Data in a new comment to CMS advocating for transparency, streamlined prior authorization processes, and robust data collection within MA plans. In the comments, LUGPA emphasized the need for standardized prior authorization protocols, clear rationales for denials, and enhanced data collection to inform evidence-based care delivery. These reforms aim to ensure Medicare Advantage plans prioritize patient-centered care and improve healthcare quality and accessibility.

divider Victory for Prostate Cancer Screening Access   

In May, LUGPA celebrated a significant legislative victory with the passage of Tennessee bill SB 2883, eliminating out-of-pocket costs for high-risk men undergoing prostate cancer screening. This success was part of a coalition effort led by ZERO Prostate Cancer, in which LUGPA played an important role. This achievement underscores LUGPA's commitment to advancing policies that promote health equity and enhance patient outcomes through preventive care and early detection.

divider Senate Finance Committee Releases White Paper on Medicare Doctor Pay Reform

In May, Senate Finance Committee Chair Ron Wyden and Ranking Member Mike Crapo released a white paper proposing significant reforms to Medicare physician payments. Key areas for reform include sustainable payment updates, incentivizing alternative payment models, enhancing primary care services, supporting chronic care within Medicare fee-for-service, and ensuring continued access to telehealth services. LUGPA will monitor any legislative developments out of the committee and continue to advocate for reforms that support private providers and guarantee access to quality care for Medicare beneficiaries.

divider New Bills Introduced to Tackle Drug Shortage

The U.S. faces persistent shortages of both essential generic medicines and critical cancer medications, affecting patient care and driving up prices. In May, Senate Finance Committee Chair Ron Wyden and Ranking Member Mike Crapo introduced bipartisan legislation aimed at addressing these shortages. The proposal seeks to establish a Medicare Drug Shortage Prevention and Mitigation Program, enforce standards for supply chain resiliency, and enhance transparency and accountability in drug manufacturing and distribution.

LUPGA has followed several proposals in Congress to address the growing drug shortage issue and will continue to follow this bill’s development.

A one-page summary of the discussion draft can be found here, and the full legislative text can be found here.


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