Wednesday, January 6, 2016

Will 2016 be a “Happy New Year” for Legislative Advocacy?

For physicians and their professional associations, 2016 will be unlike any other congressional advocacy year in recent memory.  Why?  Because when Congress last April repealed the Medicare SGR formula, it cleared the deck of the one issue that had bedeviled physicians and members of Congress for 14 years, allowing us to finally move on to other issues.

What other issues?  As I see it right now, ACP’s advocacy with Congress will now center on making improvements in healthcare policy, for the benefit of physicians and patients, in the following areas:

1. Incentives for chronic care management: starting from the recommendations we made in a letter we sent to the Senate Finance Committee to inform their newly-released Bipartisan Chronic Care Working Group options paper, we hope to see bipartisan legislation introduced and acted upon in both the Senate and House of Representatives to reduce barriers to chronic care management, including waiving cost-sharing requirements for Medicare's chronic care management codes, providing additional and dedicated payments to support the ability of physicians to manage patients with multiple chronic diseases, and reducing regulatory and administrative barriers to provision of chronic care management services.

2. Reform of meaningful use regulations: while we will continue to work with ONC and HHS to improve the meaningful use regulations, we believe that Congress has a role, both in providing oversight and enacting legislation as needed to simplify and improve the current program, especially as it transitions to the new Medicare Incentive Payment System (MIPS) created by MACRA. Congress took an important step in this direction when it passed legislation at the end of last year to allow for a blanket exemption from MU 2 for physicians who were unable to meet the 90-day reporting period requirements because CMS was so late in issuing the final MU 2 rule. We have urged both the administration and Congress to pause any plans to implement Meaningful Use Stage 3.

3. Sustainable Graduate Medical Education funding: ACP will soon be releasing joint recommendations with other internal medicine groups for reforming Medicare GME payments to support an adequate and well-trained physician workforce, particularly in internal medicine and other primary care specialties facing shortages. The paper will offer our alternatives to some of the ideas that the Institute of Medicine put forward that we found problematic. While Congress may not be inclined to enact big GME reforms this year, we believe that our recommendations could inform the discussion going forward, including bipartisan actions that might be taken in 2017 with a new administration and Congress.

4. Increased funding of key health programs: while it was very good news indeed that Congress was able last year to reach agreement on a two year deal to raise the sequestration budget caps, and that Congress also passed an omnibus appropriations bill to fund the federal government through September 30, 2016 that mostly preserved and in some cases increased funding for key health agencies, ACP will be gearing up again to lobby for continued and adequate funding for the fiscal year starting on October 1—including the Agency for Healthcare Research and Quality, National Health Service Corps, and the Title VII Primary Care Training programs.

5. Expanding use of telemedicine: we will be seeking opportunities for legislation to eliminate barriers to effective use of telemedicine, including a recommendation from our new policy paper, which calls on Medicare to lift geographic site restrictions that limit reimbursement of telemedicine and telehealth services by Medicare to those that originate outside of metropolitan statistical areas or for patients who live in or receive service in health professional shortage areas.

6. Integrating mental and behavioral health into primary care: we will be working with both the House and Senate to advance bipartisan legislation to improve access to mental and behavioral health, with a particular emphasis on integrating behavioral health into the primary care setting, as presented in our position paper published last year.

7. Restraining unjustified increases in prescription drug pricing: we will continue to advocate for legislation to restrain the unsustainable growth in prescription drug prices. To this end, ACP will be releasing a new position paper early in 2016 with our recommendations on restraining excessive price increases and increasing transparency while continuing to support innovation.

We will also continue to oppose efforts by Congress to defund or repeal the Affordable Care Act (the latest being a measure, passed by both the House and Senate through a simple majority vote using budget reconciliation, that would gut much of the law). Such efforts have virtually no chance of enactment, though, because President Obama will veto them.

All of which gets me back to the SGR, and why its repeal was such a big victory for organized medicine.  Not only did SGR eliminate the recurring threat of across-the-board payment cuts, it created the space we needed to advocate on a wider range of policies to improve access and quality, including the issues referenced above, most of which we believe can and should enjoy bipartisan support. In previous years, by having to devote most of our attention to the SGR, there was little room to pursue other issues. In that sense, 2016 really is a brand new—and potentially happy—year for physician advocacy with Congress.

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