Whilst members of Congress put together for his or her vacation recess, coverage points are persevering with to be hashed out, with the hours left to legislators working out; among the many points being resolved at this late second are questions across the extension of telehealth flexibilities, different fee mannequin reimbursement ranges, and managed care prior authorization rules.
As has turn into a routine component of Congressional operations, the U.S. federal authorities is being funded by Persevering with Decision (CR) appropriations fairly than longer-term budgeting. On Thursday night, December 17, leaders of associations representing medical teams issued statements about what was within the CR in the mean time. And, you will need to word, last-second modifications to the draft CR produced within the Home of Representatives on Thursday afternoon are nonetheless attainable.
“The well being provisions within the proposed CR characterize a blended bag for medical teams,” mentioned Anders Gilberg, senior vp, authorities affairs, at the Englewood, Colo.-based Medical Group Administration Affiliation (MGMA), on Thursday night. “On one hand, MGMA is happy that Congress heeded our name to increase telehealth flexibilities by the top of 2026, improve APM incentive funds to three.53%, and lengthen the 1.0 Medicare work GPCI flooring. These are huge wins for medical teams. Alternatively, we’re deeply dissatisfied that Congress failed to completely treatment the looming 2025 Medicare fee minimize to doctor practices. Any minimize, nonetheless fractional, is unacceptable. Lastly, not together with laws to reform prior authorization, which has the help of a bipartisan majority of the Home and Senate, almost 500 endorsing stakeholder organizations, a CBO rating of zero, and little to no opposition, represents an enormous congressional end-of-year failure and one other win for giant insurance coverage to the detriment of America’s sufferers.”
In the meantime, Aisha Pittman, senior vp of presidency affairs at NAACOS, the Washington, D.C.-based Nationwide Affiliation of ACOs, which represents the pursuits of supplier organizations concerned in accountable care organizations mentioned on Thursday night time that “The Nationwide Affiliation of ACOs (NAACOS) commends Congress for together with an extension of the Superior Various Fee Mannequin (APM) incentive at 3.53 p.c within the Additional Persevering with Appropriations and Catastrophe Aid Supplemental Appropriations Act, 2025. This important incentive empowers clinicians to drive innovation in well being care whereas bettering affected person outcomes and decreasing prices. We additionally recognize decreasing the cuts to doctor fee by 2.5 p.c, a step towards making certain clinicians are adequately compensated and motivated to embrace value-based care.”
Additional, Pittman mentioned, “Worth-based care is remodeling well being care supply by prioritizing prevention, enhancing care coordination, and increasing entry to companies past these historically lined by Medicare—all of which contribute to maintaining sufferers wholesome and extra environment friendly programs. It’s important to create pathways for all clinicians to take part in APMs that liberate suppliers from the constraints of the fee-for-service mannequin and deal with worth over quantity. NAACOS seems ahead to working with Congress to craft a sustainable, long-term strategy to doctor fee reform that helps the transition to high-value, patient-centered care,” she added.
This can be a creating information story; we are going to publish updates as new developments warrant.
