Where the last Congress fell short

The last Congress left physicians and practices in the lurch on several pieces of legislation that would have impacted health care, but didn't get passed before the end of the session.

Anders Gilberg, senior vice president for government affairs at MGMA, discusses the unfinished business from the last Congress and the negative impact it is having on physicians now.

Transcript:

Anders Gilberg: Yeah. I mean, we thought we had a reasonably good bill toward the end of the year that dealt with a couple of our really key priorities last year. we're still dealing with the aftermath of some changes that were made in 2020 to evaluation and management codes.

So offices, it codes in increasing those. It caused a budget neutrality adjustment that reduced all the other payments under Medicare. And by reducing what's called the conversion factor and by reducing the conversion factor. Congress delayed that for several years, but now we're dealing with that aftermath. And it ultimately the cut went into effect. So at the end of last year, there was a bill. It was about a thousand pages. It would fund the, the government. you know, it was a budget bill. and it had a lot of what we call extenders, healthcare extenders. So among the key ones that we were looking for was, provisions to wipe out the 2.83% cut in Medicare to the conversion factor that I'm referencing. Also, extending some of the flexibilities for telehealth that expired at the end of 2024. extending that in that bill, it extended it for throughout the year. with the eye toward, making sure that we can study the impact of telehealth on the Medicare program before you permanently, covered telehealth, in Medicare, but still like a longer term extension of those exceptions.

And also, there were some provisions regarding alternative payment models, a 3.5% bonus for practices on their fee for service payments for those practices that were also in advanced alternative payment models in Medicare. So there's a whole list of things that were going to be dealt with, taken care of. And this is where that new environment comes in that I'm not quite as used to. my recollection was Elon Musk started tweeting about it and that caused a bit of an uproar. And within a couple of days, 900 pages of that thousand page bill were scrubbed. And we had a real bare bones continuing resolution with a few healthcare things pass, which will get us to about the middle of March in terms of funding the government. And in terms of the healthcare, things that survived, the physician payment did not. So physicians are now facing, like currently under a 2.83% cut in Medicare. things that survived was a temporary extension of the exceptions for telehealth through March to the end of March. So that did survive. And, you know, we're just sort of regrouping here in terms of the physician lobby, the advocacy groups in Washington to ensure that these are issues that are taken care of here in the in the next month.

You know, ideally, we'd like to see it's happened in the past where, Congress has passed legislation to deal with physician payment and maybe not retroactively apply it, because that can be very administratively burdensome. But prorate the amount that would have been paid out, for the first few months into that final bill for the rest of the year, that happened once, about maybe ten years ago, when we used to deal with something called the Sustainable Growth Rate formula that was also causing a lot of cuts. So, yeah, we're kind of a little bit back to square one with this administration. Now that that bill at the end of the year, Had, largely been scuttled. And so it's Congress is now under the control of both houses of Congress or Republican. some of our champions have retired. Some physicians in Congress have retired. So it's a little bit of a new game. And there's a lot of issues on the table for this March mid-March budget bill. And so that's that's what we're in the mix on right now.