Promote Patient Access and Expanded Care

Promoting Access to Cancer Therapy via Medicare Part B and D:

Payment Uncertainty Challenges

One of the significant challenges faced by physicians providing care to Medicare beneficiaries is payment uncertainty. Payment delays can lead to revenue loss or increased costs for physicians, impacting their willingness to serve publicly insured patients.

Impact on Independent Practices

Medicare providers already contend with low reimbursement levels that fall behind the Medical Economic Index (MEI). Between 2001 and 2023, after adjusting for inflation, Medicare payments to physicians declined by 26%, while the costs of running a medical practice increased by 47%. These trends have made it challenging for independent, small, rural, and low-income serving practices to remain operational.

LUGPA's Advocacy for Medicare Physician Payments

LUGPA’s recent advocacy efforts include six significant reforms:

Reforming payment updates.
Promoting Physician-Focused Payment Models (PFPMs).
Reforming or repealing the zero-sum game in the Merit-based Incentive Payment System (MIPS).
Advocating for site-neutral payments.
Codifying recent administrative reforms to the Stark and Anti-Kickback laws.
Encouraging Congress to provide stable payment updates reflecting economic realities and practice costs.

Maintaining Access to Cancer Therapy

LUGPA advocates for maintaining access to cancer therapy via Medicare Part B and Part D. Physician practices administering Part B drugs should not be at risk due to pricing decisions by manufacturers. Congress can achieve savings without disrupting the buy-and-bill reimbursement system by collecting rebates directly from pharmaceutical manufacturers.

Statutory Restoration of In-Office Dispensing of Part D Medications

Importance of Patient Compliance

Efficacious care depends on patient compliance with prescribed medications. Between 20 to 31% of drug prescriptions are never filled, leading to increased healthcare costs and adverse health impacts. In-office dispensing can improve patient access, care coordination, and compliance monitoring.

Effectiveness of Physician Dispensing

Physician dispensing, permitted in most states, enhances care coordination and patient adherence. A 2021 study found no significant differences in clinical outcomes between physician- and pharmacist-dispensing, highlighting the benefits of in-office dispensing.

Challenges from CMS FAQ

In 2021, CMS released a FAQ limiting in-office dispensing, which could negatively affect access to prescription medications. LUGPA advocates for the rescission of this FAQ to protect access to life-saving treatments.

Ensuring Continued Access to Cancer Therapy Through Medicare

LUGPA supports efforts to ensure that physician practices are not negatively impacted by manufacturers' pricing decisions for Medicare Part B and Part D therapies. Advocating for molecular urine testing and diagnostic genetic testing for prostate cancer aligns with LUGPA's mission to provide high-quality, individualized care.

Supporting Healthcare Price Transparency

Federal Rules on Price Transparency

LUGPA supports healthcare price transparency, which is essential for patients managing their healthcare expenses. Federal rules CMS-1717-F2 and CMS-9915-F require hospitals and payors to post pricing information online, but compliance has been low.

LUGPA’s Recommendations

LUGPA has submitted testimony to the House Energy & Commerce Health Subcommittee, calling for:

Enforcement of the hospital transparency rule.
Equalizing payments across different sites of service.
Requiring a minimum level of charity care for hospitals to earn non-profit status.
Repealing the inpatient-only list.
Reforming the Stark law to allow physician ownership of hospitals.

LUGPA remains committed to working with other organizations to improve patient access to high-quality care at lower costs, promote communication and coordination, and enhance healthcare price transparency.