Senate Finance Committee holds hearing on Medicare payment reform for chronic care

Senate Finance Committee holds hearing on Medicare payment reform for chronic care

The Senate Finance Committee recently held a full committee hearing on reforming Medicare payments to improve chronic care. While there were some comments in favor of increasing payments to physicians, most of the discussion centered on value-based care. The Committee accepts written statements for the record from outside stakeholders until 10 days after the hearing and the Advocacy Council submitted comments expressing our views on the topics discussed.

Our comment letter described the role allergists play in managing chronic conditions for patients with allergies and asthma. It also advocated for sustainable reimbursement reforms and reducing administrative burdens. In addition to these recommendations, the letter urged CMS to consider physician-focused payment models (PFPMs) such as the model developed by the College to reform Medicare payments for chronic care.

There was broad agreement among members of the committee and witnesses that payment reforms are necessary to better support the management of chronic conditions for Medicare beneficiaries.

Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) emphasized that current payment policies need to be improved. Witnesses echoed this by adding that coding complexities and prior authorization requirements exacerbate administrative burdens for physicians and other health care professionals.

The hearing featured some discussion on opportunities to reform reimbursement including:

  • Positive annual updates to the conversion factor.
  • Revising the budget neutrality threshold for physician fee schedule adjustments.
  • Supporting primary care providers with monthly prospective payments.
  • Testing physician-focused payment models recommended by the Physician-Focused Payment Model Technical Advisory Committee (PTAC).
  • Reducing beneficiary cost-sharing for care coordination services.

Committee members and witnesses also called attention to how inadequate payments to practices are causing office closures, increased wait times for patients, and higher rates of clinician burnout. These impacts are further exacerbated by administrative burdens practices face.

The Merit-based Incentive Payment System (MIPS) received significant attention. Witnesses contended that metrics for the MIPS program are not clinically relevant; therefore, they provide little meaningful information for health care professionals to improve care for their patients. Dr. Amol Navathe, professor at UPenn and Vice Chair of the Medicare Payment Advisory Commission (MedPAC), shared the Commission’s position that Congress should replace MIPS entirely.

There were similar criticisms for alternative payment models (APMs). Witnesses explained that more time is needed to test models to understand the impact on quality and cost savings. Witnesses supported prospective payments for APM participants, which could help support practices who are interested in participating in APMs but do not have the means to do so.

Ideas to improve chronic care included reforming value-based payment models with an emphasis on patient-centered care, incentivizing providers to participate in accountable care organizations (ACOs) and improving quality measures. One suggestion was to reduce or eliminate patient cost-sharing for care coordination services. There was also broad recognition that telehealth can play an important role in chronic care management.

Medicare Advantage was also discussed within the context of chronic care and also within other care situations. Comparing traditional Medicare to Medicare Advantage, lawmakers and witnesses expressed concern about prior authorization requirements, changes to drug formularies, and high spending in advertising of MA plans.

Other discussion topics included advanced care planning, hospice care, and the influence of private equity in health care.

Overall, committee members and witnesses emphasized their commitment to working on this issue, citing past bipartisan collaboration and the creation of a Medicare payment reform working group earlier this year, which includes Finance Committee members Catherine Cortez Masto (D-NV), John Thune (R-SD), Debbie Stabenow (D-MI), Marsha Blackburn (R-TN), Mark Warner (D-VA), and John Barrasso (R-WY).

Next week, members of the College’s Advocacy Council will travel to Washington, D.C. for our annual “Strike Force” Capitol Hill advocacy day. Increasing Medicare payments to physicians and reforming how Medicare payment rates are determined are among our key advocacy topics.

Interested readers can rewatch a video recording of the hearing on the Committee’s website.