Congress Partially Mitigates the 3.4% Medicare Physician Payment Cut
In March, Congress passed legislation to reduce the 3.4% Medicare physician payment cut by 1.68% in a federal budget deal to avoid a government shutdown. The new payment was not retroactive and went into effect on March 9, 2024.
The partial mitigation of the Medicare payment cut comes after significant advocacy, including grassroots, lobbying, and several letters to Congressional Leadership. Specialty physicians and the house of medicine have made it clear that physicians are struggling to maintain access to care for the Medicare beneficiaries they treat. Reductions in Medicare payments, rising practice costs, workforce shortages, and financial uncertainty resulting from the pandemic are causing some physician practices to limit the number of Medicare patients they see or the types of services offered. These cuts are disproportionately impacting small, independent practices, like those in rural and underserved areas that continue to face significant healthcare access challenges.
Specialty physicians continue to push Congress to advance comprehensive solutions to the unsustainable Medicare physician payment system – such as H.R. 2474, the Strengthening Medicare for Patients and Providers Act. The bipartisan bill, with 133 co-sponsors. would provide physicians with an annual, permanent inflationary update in Medicare tied to the Medicare Economic Index. Relatedly, a group of bipartisan Senators, led by Senators Cortez Masto (D-NV) and Blackburn (R-TN), announced a Medicare Payment Reform Working Group.
It’s time for Congress to pass legislation that creates a long-term, sustainable, and fair solution for Medicare physician reimbursement.
Massive Cyberattack Upends Healthcare System for Patients and Providers
On February 21, UnitedHealth Group (UHG) disclosed to the Securities and Exchange Commission that it had suffered a “material cybersecurity incident.” That incident 
was a cyberattack on Change Healthcare, a clearinghouse owned by Optum, which is, in turn, owned by UHG. As a result of the attack, Change was immediately taken offline.
This situation has left medical providers who relied on Change for their claims processing and reimbursement in an immediate financial crisis. Change processes 15 billion health-related transactions annually and operates a digital clearinghouse that connects doctors, hospitals, and other health providers with insurance companies that pay for medical care and authorize medical services.
On March 5, the Department of Health and Human Services (HHS) issued a statement regarding the ongoing situation, which announced actions that the Centers for Medicare and Medicaid Services (CMS) took to help providers through this crisis. Those actions included the creation of flexibilities so that providers could switch clearinghouses more easily. Following that, CMS issued guidance for Medicare Advantage organizations and Part D plans to encourage them to temporarily pause or limit utilization management requirements and timely filing requirements. CMS also contacted every Medicare Administrative Contractor (MAC) to ensure they are prepared to accept paper claims submissions. Additionally, after hearing about the difficulties providers are experiencing with getting answers from healthcare plans, the US Department of Health and Human Services (HHS) released a provider resource packet they compiled which includes tools, information, and resources directly from health plans and payers for providers in need of assistance.
In April and May, Senate and House Committees with healthcare jurisdiction held hearings to investigate further the cyberattack’s causes and its impacts on patients and providers. These hearings included appearances by United Healthcare CEO Alex Witty before the Senate Finance Committee and the House Energy and Commerce Oversight and Investigations Subcommittee. Before both panels, Witty pledged to provide financial assistance to providers for “as long as it takes” to get claims and payments flowing at pre-cyberattack levels.
The Alliance of Specialty Medicine and its member societies will continue to monitor this situation and provide status updates as appropriate.
SIR Supports Legislation to Improve Blood Clot
Education and Prevention
The Society of Interventional Radiology (SIR) is asking Congress to support the “Charles Rochester Blood Clot Prevention and Treatment Act” (H.R. 5699), introduced by Rep. Lisa Blunt Rochester, D-Del., in memory of her late husband, who passed away due to a blood clot at the age of 52. The bill directs the Centers for Disease Control and Prevention to launch a national campaign to increase public awareness of blood clot signs and symptoms. It would establish an advisory committee to help streamline effective diagnosis, treatment, and prevention of blood clots and pulmonary embolisms.
SIR is also partnering with Rep. Blunt Rochester to increase awareness and understanding of the important role IR can play in the treatment of blood clots. Recently, SIR
contributed to the Blood Clot Awareness, Action and Advocacy Toolkit distributed by Rep. Blunt Rochester. The toolkit was shared during a livestream, which featured SIR member Assaf Graif, MD, who discussed the importance of blood clot awareness that can lead to early treatment of blood clots. We encourage you to download and share the toolkit with your patients and colleagues.
A Weekend of Resilience, Hope, and Unity Around CRC Screening
Bahar Adeli, MD
Recently I had the privilege of representing the American Gastroenterological Association (AGA) in Washington, D.C., participating in an event that was both heartrending and inspiring: the United in Blue Rally and the Fight for Colorectal Cancer Advocacy Day on the Hill. It was a gathering that showcased the epitome of human resilience, hope, and the unwavering spirit of those affected by colorectal cancer (CRC).
As a physician, the journey through the medical field is replete with encounters of human suffering and triumphs over illnesses. However, nothing could have prepared me for the profound connections I would make with the beautiful souls I met that weekend. From survivors who have been cancer-free for over 20 years to those freshly diagnosed and fighting bravely, each person’s story was a unique testament to the human spirit’s indomitability.
Among these remarkable individuals were also caregivers, some of whom have faced the agony of losing loved ones to this disease, while others live with the haunting genetic predisposition that took their loved ones away. Yet, in the face of such adversity, there was a palpable sense of unity and purpose. Through our conversations, a clear call to action emerged: it was time for our policymakers to make immediate, impactful legislative change to prioritize CRC by giving us a bipartisan commitment for substantial funding and a promise to support policy solutions that improve all of our lives.
The weekend wasn’t just about solidarity. Amid these powerful stories and shared experiences, there was a clarion call to action for policymakers for immediate and impactful action. We need our legislators to recognize the urgency of the situation and to prioritize CRC now with a bipartisan commitment to substantial funding and advocacy.
Lives are currently in jeopardy. What was once considered sufficient falls markedly short now. Every moment counts in the battle against this formidable foe. The time for change is now.
One of the most poignant moments for me was realizing the power of perspective. Amidst the discussions, a survivor shared a thought that resonated deeply with me: “Every day is a bonus day.” This simple yet profound statement reminded me of the preciousness of life. It echoed the reality that our existence is, in itself, miraculous, and every day we are given is an opportunity to make a difference.
The weekend was not just about sharing experiences but also about learning from them. The courage, humor, and zest for life exhibited by those with stage four colon cancer were incredibly moving. Their determination to make a difference, despite the odds, was a powerful reminder of the strength inherent in human resolve.
As I walked among the flags in front of Capitol Hill, each representing the lives that could be saved through early screening, I was reminded of a universal truth that transcends our external differences – we are all the same on the inside. This experience reinforced my conviction in the importance of compassion, understanding, and collective effort in the fight against colorectal cancer.
My time in D.C. was an enriching experience that deepened my understanding of both the challenges and the incredible resilience faced by those affected by colorectal cancer. It reaffirmed the importance of awareness, early detection, and the continuous search for a cure. As we move forward, let us all remember that every day is a bonus day, and together, we can make a significant impact in the fight against this disease.
Alliance Submits Testimony on Medicare Physician Payment
The Alliance of Specialty Medicine submitted testimony for the record to the US Senate Finance Committee addressing the challenges and concerns regarding Medicare physician payment and quality improvement programs. The testimony was submitted as part of the committee’s April 11 hearing, “Bolstering Chronic Care through Medicare Payment.”
In its testimony, the Alliance emphasized the need for stabilizing and improving Medicare physician reimbursement and performance programs through legislative
reforms. They proposed various actions to address these issues, including replacing flat base payment updates with annual updates based on an appropriate inflationary index, exempting certain benefits and services from budget-neutrality adjustments, and requiring consistent updates of key data inputs used to set Medicare payments. They also highlight the need for more granular evaluations of the impact of the Quality Payment Program (QPP) and Physician-Focused Payment Model Technical Advisory Committee (PTAC) on healthcare quality and value. The entire testimony can be accessed by clicking the link below.
Alliance Statement for the Record SFC Medicare Physician Payment 04.11.2024