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ACP continues to advocate for Congress to prioritize a payment fix and include it in future legislation

Jan. 26, 2024 (ACP) -- The beginning of 2024 brought challenging news for the nation's physicians as Congress did not adopt legislation to reverse across-the-board cuts to Medicare payment rates, despite pressure from the �鶹ֱ��app and other medical organizations. However, there is a positive development: The crucial G2211 code survived potential threats, a major victory for ACP and internal medicine physicians.

On the reimbursement front, “as has been the case for the past few years, physicians are once again navigating an across-the-board cut to Medicare payment rates,” said David Pugach, ACP vice president for governmental affairs and public policy. “This is a byproduct of policies intended to constrain the growth of spending in the Medicare Physician Fee Schedule that takes an arbitrary ‘zero-sum game’ approach to payment for physicians' services.”

Legislation was introduced in the House of Representatives in December to stop the cut from going into effect, and ACP and other physician associations rallied behind H.R. 6683, the Preserving Seniors' Access to Physicians Act of 2023.

Medical societies, including ACP, urged Congress to include it with appropriations legislation that needed to be enacted by Jan. 19. However, negotiations relating to Medicare payment and other health care programs did not reach a resolution, and congressional leaders agreed to only extend funding for federal programs through early March.

While the path forward is challenging, “ACP and other groups are pushing hard for Congress to prioritize a payment fix and include it as part of any moving legislation,” Pugach said.

“Stabilizing the health care system, which included stopping payment cuts, was a priority for congressional leaders during the COVID-19 pandemic. Unfortunately, there are other issues that now compete with -- and even potentially conflict with -- providing additional funding for the Medicare Physician Fee Schedule,” he explained. “Additionally, the legislative calendar and political environment make it harder to move any legislation and reach a resolution on issues requiring leadership negotiations.”

Although it has bipartisan support, the Preserving Seniors' Access to Physicians Act of 2023 has not been a priority for either Democratic or Republican leadership, according to Pugach.

“All of these challenges add to the urgent need for physicians to contact their members of Congress and explain how stopping this cut will help protect patients' access to care and why they need to prioritize resolving this issue,” he said. “As of mid-January, the bill had 44 cosponsors -- 35 Republicans and nine Democrats. Increasing cosponsorship of the bill from both sides of the aisle will help influence congressional leaders to include it as part of a legislative package addressing other unresolved health care issues.”

Pugach said that members of Congress have also introduced legislation that would resolve some of the systemic deficiencies in the Medicare Physician Fee Schedule. In addition to advocating for legislation to stop the current cut, ACP has also been advocating for legislation that would raise the threshold for budget neutrality payment cuts and for legislation that would update the Medicare Economic Index. He shared that “the path forward on these issues is certainly not easy, but there is bipartisan recognition that these types of reforms are needed. As with most issues, one of the hurdles is addressing the cost of these policy changes.”

Meanwhile, the 2024 Medicare Physician Fee Schedule also implemented the G2211 code, and Congress did not delay its implementation. “The code is now being used to pay for the additional resources needed for patients who have serious conditions and a longitudinal relationship with their clinicians,” Pugach said. “The implementation of this code had been previously delayed to help offset the cost of a previous payment fix during the COVID-19 pandemic.”

However, he cautioned that the code is not yet home-free. “It feels a little premature to say that the threat to the G2211 code has passed entirely while issues relating to the 2024 Physician Fee Schedule are still outstanding,” he said. “However, it is much harder for Congress to do anything that would disrupt use of the code now that physicians are actively utilizing it.”

For now, Pugach said, “ACP is working to help our members understand how and when to use the code, and we also want to encourage internal medicine physicians to continue educating lawmakers on the importance of the code and how they use it to support patient care. When using the code appropriately, it can offset 90 percent of the budget neutrality cut.”

With the latest short-term extension of federal funding, the new deadline for Congress to pass annual appropriations bills for the current fiscal year is in early March. “In the course of finalizing work on appropriations, Congress also has to reauthorize and fund a number of federal health care programs, including community health centers, the National Health Service Corps and the Teaching Health Center Graduate Medical Education program,” Pugach noted. “Hopefully, negotiations over funding levels will be complete by the March deadline and a Medicare payment fix will be included as part of an appropriations package, if it is not included as part of another legislative package before then.”

Back to the January 26, 2024 issue of ACP Advocate