The House Ways and Means Committee’s Health Subcommittee held a hearing titled “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.” It featured a panel of witnesses from independent medical practices across the country and one prominent academician to share their experiences and recommendations for how to address the issues.
The hearing featured discussions about the many financial and administrative burdens that make it more difficult for independent practices to remain open and independent. While the specific topics discussed may be familiar to allergists, the elevated platform in this hearing will give the issues more visibility.
There was broad agreement among subcommittee members and witnesses that physicians need higher Medicare reimbursements. Witnesses detailed how their practices are facing higher labor and other input costs, which have far outpaced increases in their reimbursement rates.
Most of the discussion centered on how to apply an inflationary adjustment to physician payments. While there was general consensus for some form of adjustment based on medical inflation as measured by the Medicare Economic Index, there were disagreements as to whether it should be a full or partial MEI adjustment.
The hearing also focused heavily on the burdens of Medicare Advantage plans. Witnesses highlighted how burdensome prior authorization, plus unfair delay and denial tactics, make it harder for independent practices to remain viable. Witnesses described how MA plans use prior authorization and AI algorithms to deny or delay coverage of medically necessary services, which force physicians to fight for reimbursements through appeals. Many choose not to invest the time and resources into this fight, which allows the health plans to retain more profits. Witnesses asked the committee for more oversight of MA plans’ use of prior authorization and AI to deny or delay coverage of care.
Another discussion topic was the disparity between hospital outpatient payment rates and physician fee schedule (PFS) payment rates. Hospitals are incentivized to purchase independent practices so that they can earn higher payments. Witnesses spoke of the urgent need for more site-neutral payment policies to level the playing field between hospital and physician payment rates.
The topic of consolidation was not limited to hospitals. Current financial and administrative burdens also incentivize practices to sell to private equity firms. There was discussion on the impact and value of private equity in health care, and much of it was critical, including how these firms will employ more aggressive billing tactics and push physicians to change how they deliver care to earn higher profits – most of which go back to the private equity firm, not the physicians. Witnesses advocated for more transparency and scrutiny of private equity in health care.
The MIPS program was also criticized during the hearing. Witnesses spoke about how success in MIPS is determined by how competent your EHR system is at reporting the data. They were emphatic that there is no correlation between MIPS performance and clinical outcomes. Specific solutions were not discussed in detail, but it is clear the Subcommittee and the witnesses agree MIPS is not working as intended.
The Change Healthcare cyberattack was not a prominent topic during the hearing. Other topics included how AI can be used to help alleviate burdens on physicians, the need for increased medical residency funding, and the need for more cost transparency. One witness highlighted how the recent Federal Trade Commission (FTC) final rule to ban most noncompetes will make it easier for physicians to start independent practices. Another topic that was briefly discussed was how doctors sometimes practice “defensive medicine” to protect themselves from aggressive medical malpractice lawsuits.
The Advocacy Council submitted written statements for the hearing record and will advise College members of any further activity in this area.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
