Transcripts For CSPAN2 Health 20240703 : vimarsana.com

CSPAN2 Health July 3, 2024

The subcommittee will come to order, we will now resume with our second page, our witnesses for the second panel, i have to put my glasses on, sorry about that. Dr. Debra pat, texas oncology. Dr. Fer, youre recognized for 5 minutes for your opening. Program meant to do. I stayed there and continue today serve that community. Ive stayed therefore ever since. My training has allowed me to develop longterm relationships with my patients and deliver patient centered primary care. Were not called Family Medicine physicians just because we treat the whole family. We are called Family Medicine physicians because our patients are part of our extended family. Being a rural family physician is incredibly rewarding but in the last several years its gotten much more difficult. My patients have more chronic medical problems that require complex ongoing care management, more and more they are looking to our practice to help with the depression and anxiety, Meeting Basic Needs and navigating increasingly complex Healthcare System. But instead of providing primary care practices with support to meet the growing patient needs we are left struggling to stay afloat as payment shrink and administrative requirements multiply. Our failure to invest in framary care is being failed across the country in Patient Outcomes and repeated challenges trying to find a primary care physician. Data released just this week shows that over 16,000 primary care physicians have left the workforce over the past year but as country we have never needed primary care more than we do today. Despite much higher spending per person the u. S. Spends less on primary care has the highest rates of people with chronic conditions, the lawest Life Expectancy and highest preventible death rates compared to our peer countries. In other words, primary care is uniquely suited to help address the pressing healthcare problems we face today. Im leased to see subcommittees on ways to support physicians with patient centered work that we and do tangible reduction in administrative workload. We encourage by steps medicare has taken to more appropriately value Physician Office visits. In 2024 cms has proposed incremental step to better value primary care. The g 221st addon code would better account for time, resources and expertise involved with providing comprehensive primary care. Primary care Office Visits are more complex and g2211 is intended to recognize that. Opportunities meaningfully invest in primary care under our Current System are rare but this is one of the few of them that we can use. I urge congress to support implementation of this code. However, coding and billing challenges alone wont fix the broken physician medicare Payment System. We need congressional action. I strongly urge congress to reform budget and neutrality requirements, enact annual inflationary update for physician payments, support Physician Practices moving into valuebased payment models and pass the lower cost more transparency act. But strengthen medicare patients go beyond just improving payment. Congress mustards Administrative Burden which has become totally unmanageable. My staff and i spent hours every day navigating prior authorization and therapy requirements that prevent patients from being able to access evidencebased treatment in a timely manner. Thankfully the subcommittee has the opportunity to address some of these issues by first passing the seniors timely access to care act. Reforming step therapy in medicare and medicaid requiring Medicare Part b coverage of all recommended vaccines so that we can give all vaccines in our office and i have to go to the pharmacy for that. Standardizing quality measures across payers and programs. Primary care in this country is at a Tipping Point but congress can help to change that. Improving payment reduce the Administrative Burden would not only be investment in primary care but also in our patients and your constituents. Thank you for the opportunity to provide this testimony, i look forward to trying to answer your questions. Thank you for your testimony. Dr. Pat, youre recognized for 5 minutes for your testimony. I think your mic, hit the mic button. I appreciate for the opportunity to testify on the diagnosis of america. A large physicianowned private practice in the great state of texas. I serve as executive Vice President of oncology. As you consider policies in todays hearing i want you to envision consequences of inaction. Continued medicare fee schedule payment cuts pose real and serious threats to medicare fiduciaries accessing medical care, causes Chain Reaction that results in provider inadequacies and decrease quality of care for Medicare Beneficiaries. The disproportionate burden felt by nonhospital affiliated practices like mine, disparity reimbursement in Hospital Systems that are driving up the cost for medicare care for all americans. We face cuts can. Since 2014 medical inflation has increased every year yet medicare has only decreased, the ever widening gap can be seen in the graph including in my written testimony that shows medical inflation risen by 28. 4 since 2014. We have issues of network adequacy, quality of care and physician burnout. Cms is constantly cutting medicare reimbursements for physician as natural consequences that harm Medicare Beneficiaries as a result of decrease. I have to juggle and ask favors to be seen by primary care physicians or another specialists so i have to use my time. I have to refill primary care medications and frequently have gaps in care where no one is refilling their medications and they go without diabetes or hypertension medication. This causes fragmentation and delays in appropriate care. According to recent study 145,000 healthcare practitioners left the Healthcare Industry from 2020 through 2021 threatening access to medical care, 71,000 of these were physicians. This is alarming. We face staffing shortages. The burden of declinement reimbursement has been compassion herbated by National Crisis and shortage in healthcare staffing. Just last week you might have seen announcement after Kaiser Permanente increase payment. Only challenge further by inflation how would i pay for increases in staffing to continue to staff my clinics and be competitive . The natural consequence of this is brother and sister Cancer Patients arent able to get mammography. Cancer Infusion Centers and facilities arent able to open to capacity because we have staffing shortages. We are on a verge of major crisis in medical care. However, because respect systems receive inflation adjustment the physicians in private practice do not and gap between physicians and hospital reimbursement is resulting in consolidation of medical care. This is especially true with hospitals, top 40b hospitals showed that markup cancer drug unbelievable 5 times, if you have a cancer drug that costs the hospital 5,000 it can be marked up to 25,000. In addition by ignoring Hospital Survey data, cms is everpaying 340b hospitals close to 50 contributing to premium increase that they will pay in 2024. We need to pass meaningful legislation. I want to underscore that its critical for congress to fix the looming cut with much needed inflation update. Congress needs to make payments equitable in the hospital and private practice settings by passing site neutrality legislation and fix b340b. As doctor in private practice we need you to consider legislation and make meaningful change. Fragmented an disruptive medical care for beneficiaries. We need you to act now. Thank you for your time and im happy to take any questions. Thank you for your testimony. Yes. Youre recognized for five minutes for your testimony. Think tank dedicated to empowering patients an reforming programs. I want to thank you for inviting me here today to discus payment policy in medicare. My testimony today reflects my own views. Medicare payment policy should reflect 3 key goals, first, maintaining access to care, second, minimizing costs and third improving payment accuracy. We should all be committed to securing seniors access to health care. Fortunately 98 of physicians accept medicare rates and this pour cent and increased over time. Policies that increase Administrative Burden or underestimate physician pay could undermine this. These costs directly onto the shoulders of beneficiaries through cost sharing and premiums, just last week cms announced that part b premiums will increase by roughly 6 next year due the rising medicare spending, on average seniors already spend 28 of their Social Security checks on expenses in parts b, d alone. The fiscal sustainability of medicare itself is also crucial. Part b which covers Physician Services is the fastestgrow part of medicare. The Medicare Trustees project that this trust fund which is mostly financed by general revenues will consume over one fifth of federal income tax renew by the end of the decade. Rising costs will directly contribute to deficits which may result in benefit cuts, tax increases and economic harm in the future. Finally, medicare policy directly distorts decisions in the healthcare sector. Fee for Service Payment encourages higher volume of healthcare procedures regardless of quality. Both congress and cms have historically struggled with medicare policies. Under the Sustainable Growth rate before that, the per unit price of Physician Services is stagnated which help to control overall spending, however, the volume and intensity of such services on per enrollee basis grew. Maintaining lower payment rates may compromise participation by doctors. So far data by cms, access to Physician Services is stable or improving, however, congress could ebb act policies that would improve medicare payment policy on these dimensions for beth beneficiaries and taxpayers. First congress should offset with savings. Part b drugs and other areas have grown rapidly. Common sense policies like neutral payments or reducing statutory overpayments on drugs can save hundreds of billions of dollars without making any changes to benefit seniors benefit. Second, congress should adopt more marketbase pricing for doctors. The current process leads to absorbable errors in payment rates and disparities between specialties have reduced supply. Market competition to determine away the economic value of service. Gradual improvement is possible by tieing medicare policy to rates negotiated by Medicare Advantage plans. Third, congress should eliminate quality payment programs like mips and the financial incentives for advanced participation. These policies have been the clearest failure of macr ample and responsible for clinician burden without improving value. A recent cbo report that they have lost instead of saving money. It does not make stones subsidize in models that do not work. Quality metrics are best when they enable seniors to make informed choices between coverage and care options. This is already possible in Medicare Advantage which has become increasingly popular in recent years. Policymakers should ensure that it remains a vital option for seniors and encourage participation between ma and fee for service. Removing government distortions than adding new ones is a much more effective way to maintaining access to payment care and improving accuracy. Thank you, i look forward to answering your questions. My name is matthew and im Health Economist and senior fellow at the brookings institution. Im grateful for the chance to appear before you to discuss ways how medicare pays physician. I want to begin by discussing the tradeoff involved in deciding how much medicare pays physician. Broadly excuse me, first ensuring that medicare can access highquality physician care. The second is limiting the cost that higher payment rates imposed in taxpayer that bear Program Costs on beneficiaries who bear medicare premiums and cost sharing and even the privately ensured when medicare pays more. Data on how well Medicare Beneficiaries are able to access physician care can help policymakers if they were to balance access and cost and that saying i want to highlight two facts. First, survey data shows that most medicare fiduciaries do not currently report major problems accessing physician care. In 2022 around four fifths of beneficiaries searched for primary care provider said they had no problem or small problem finding one. Nine and ten that saw new specialist thought the same thing. Twothirds of beneficiaries reported never waiting longer than they want today to get an appointment and more than half said the same for routine care and along all of these dimensions Medicare Beneficiaries report comparable or slightly better access to physician care than the privately ensured. This could indicate the changes in medicare payments currently only have a modest affect or alternative Greater Alliance on nonphysician professionals and offsetting in physician payment rates. Looking ahead it is possible that the Delivery System might respond differently to future payment changes than it did to past one. Perhaps especially cost outpayment rates indefinitely. Additionally, under current law would outpay by more during the next year or two than they did during typical year in the past two decades. The data im speaking to here doesnt address outcomes other than access like quality. Nevertheless recent history does suggests theres some scope to grow more slowly than input costs in the years to come without decline in access. In the time i have left i want to briefly highlight four structural changes how medicare pays physicians that are word considering regardless of what policymakers decide on level of payment. The first is eliminating the meritbased incentive system which evidence suggests is failing of improving quality and efficiency of patient care and creating costs for clinicians. Since eliminating mips and second maintaining bonuses or apms rather than allowing to sharp. Well designed apms do appear to improve efficiency of patient care and current payment encourages model uptick and flexibility to improve their design. The third is insulating future physician payment rates from inflation shocks but in a budget neutral way. Physician payment updates are currently fixed in law to shocks can cause inflation adjusted payment, rates to be higher or lower than expected. This could be avoided without a large score card and payment updates should equal index minus an appropriate fixed percentage. The fourth which takes me beyond physician payment per se is adopting ambulatory services as subcommittee is considered and the benefits of neutral payment in terms of reducing cost and beneficiaries and removing incentives for consolidation are likely familiar so i will not repeat them but i will note that payment differences wily grow over time which will magnify the importance of sigh neutral payment. Thank you, again for the opportunity to testify, i look forward to your questions. Thank you very much. That conclude it is testimony. We will move to members questions. I will recognize myself for five minutes. I want you to clarify you said four fifths of people medicare patients dont have a trouble finding new primary care physician, that means a fifth of them do. You presented that kind of that was a positive number. From my perspective, thats awful. A fifth of medicare patients when they lose their primary care doctor or their doctors retire cant, are struggling to find a new physician, is that what you said . So thats correct, yes. I think that the question is relative to what, thats a far better number than we observed in private insurance and separate question to the extent to what extent would increase payments actually address that problem. Yeah, so the reality is then its a chicken or the egg, right because we have shortage of primary care physicians because of reimbursements. People cant find their doctor. Youre saying payment doesnt matter but im saying thats the root cause of the problem. Right, and i think it is possible that payment matters to some degree and those access measures are better for Specialty Care than primary care and so that might consistent that payment does matter at the margins. I think what is true is given as we have seen a large decline in payments without large, the question is how much does it matter. I think i mean, youre an economists but the economists need to take a tour through rural Southern Indiana and maybe it might change your view. You also said about about specialists twothirds of seniors and last number was just over 50 of seniors. Can you clarify those because, again, those are awful numbers. Twothirds is the number of people that reported never waiting longer than they want today for an appointment. So a third do. Many of the people are responding that they actually fair enough. Theres a tradeoff how much can you improve access for a given amount of yeah. Fair enough. Dr. Pat, i understand you run your own practice, many are facing 10 cut this year. As an independent physician, can you share what an 8 or 10 cut would mean to your ability to practice and what that might mean access for patients. In your patient you talk about that briefly but can you clarify that even more . Yes, sir. So when we have decreases in reimburse meant, you know, that has a trickledown effect to

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