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WASHINGTON – In a House Energy and Commerce Subcommittee on Health hearing this week, U.S. Representative Larry Bucshon, M.D. (R-IN-08), who serves as Vice Chair of the Health Subcommittee, covered a wide range of policies to improve the Medicare program for our nation’s seniors. In the hearing titled, “What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors,” Dr. Bucshon specifically spoke on bipartisan legislation he has championed to remove certain prior authorization restrictions from Medicare Advantage, ensure physicians are reimbursed appropriately, and promote value-based care. Dr. Bucshon questioned Mr. Joe Albanese, Senior Policy Analyst of Paragon Health Institute and Dr. Debra Patt, Executive Vice President of Texas Oncology. 

Dr. Bucshon opened the hearing with the following remarks and you can watch his comments here. 

“This hearing means a lot to me; as a provider myself, many of the issues on today’s agenda are priorities of mine. Ensuring patients have access to quality providers is the most fundamental reason why I came to Congress in the first place. I want to talk for a moment about why this hearing is so important. Providers choose to work health care because they care about people. They invest years—often decades—of their lives to training. And then they work grueling hours. They sacrifice time for themselves and time for their families to take care of patients. And while they’re working, they have the lives of others in their hands, which can be incredibly stressful. We owe it to these providers and their patients to allow them to focus on patient care—not worry about the massive amount of paperwork waiting for them at the end of the day, or about long-term ability to operate their practice. We know Medicare is the single largest payer for health care services in this country, and often shapes how private plans approach coverage. It is critical that we ensure Medicare operates in a way that supports providers, thereby ensuring that the millions of seniors who rely on Medicare continue to have access to their doctors. My passion for this issue is why I’ve worked for many years to get the Improving Seniors’ Timely Access to Care bill across the finish line, to remove certain prior authorization restrictions from Medicare Advantage. It’s why for years I’ve led the charge on bipartisan efforts to ensure that physicians are reimbursed appropriately, including HR 2474 to provide them with inflationary updates to reimbursement levels. And it’s why I believe strongly that we must pass legislation to promote value-based care, as was intended when Congress passed MACRA in 2015. I hope my colleagues will join me today in recognizing the importance of these issues and commit to working with me and others on this committee to ensure provider access for Medicare patients.”

BACKGROUND

As a cardiothoracic surgeon for more than 15 years, Dr. Bucshon remains committed to finding real and feasible solutions on all matters that will benefit health care professionals and improve patients care and access. In Congress, he has continued to promote a more modern, innovative, and flexible healthcare agenda that emphasizes lower costs, keeping people healthy, finding better therapies and cures, and giving all Americans a wide array of choices to provide them with peace of mind. 

Physician Reimbursement 

America’s physicians have more than stepped up to the challenges that they have encountered over the past three years. Throughout the pandemic, they put in countless hours, often risking their own health and safety to keep our communities healthier and safer. Even now, physicians nationwide continue to face grueling hours and widespread burnout that is undermining our nation’s healthcare workforce and threatening patient access and affordability. What’s more, many physicians today are working under an unsustainable Medicare payment system that fails to adequately reimburse them for the critical, life-saving services they provide. When adjusted for inflation, Medicare physician payments declined by 26% from 2001 to 2023. 

Dr. Bucshon has been working for over a year now toward reforms of the dysfunctional, unsustainable Medicare Physician Fee Schedule. Last fall, he led a bipartisan RFI requesting feedback from stakeholders on potential improvements. And in the spring, a bipartisan group of Doctor Members introduced H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would tie physician reimbursement to MEI. It has been very successful in raising awareness of the fact that physician pay is not adjusted for inflation. This week, the Hill published a joint op-ed led by Dr. Bucshon, Dr. Miller-Meeks, Dr. Bera, and Dr. Ruiz on the importance of passing H.R. 2474. 

Value-Based Care

Dr. Bucshon continues to believe it’s critical that Congress work to improve value in health care delivery.

Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) with the intent of moving away from a payment model that rewarded physicians for delivering higher volumes of procedures toward a system that would ensure they were paid for the value of the work they do to keep patients healthy. It has become clear, however, that additional reforms are necessary to accomplish this goal. 

In order to continue progress in promoting value-based reform, Dr. Bucshon led a bipartisan group of members seeking feedback from health care providers, advocacy organizations, health economists, and others regarding actions Congress should take to stabilize the Medicare payment system. The group received over 130 responses from stakeholders, discussing everything from reworking Alternative Payment Models to adjusting the way Medicare dollars are spent.

This has started a productive conversation about committee work on the issue and legislation. 

This summer, Dr. Bucshon led the bipartisan introduction of the Value in Health Care Act (H.R. 5013), a bill that will make commonsense changes to the program parameters of Alternative Payment Models to incentivize participation in Accountable Care Organizations (ACOs). 

The Value in Health Care Act would:

·    Extend advanced APM incentive payments for two years.

·    Provide greater technical support to ACO participants to help cover the significant startup costs associated with program participation.

·    Establish guardrails at CMS to ensure that the process to set financial benchmarks for ACOs is transparent and appropriately accounts for regional variations in spending.

Improving Care for Seniors

Many Medicare Advantage plans require providers to obtain prior authorization for certain medical procedures and tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive appropriate treatments and help control the cost of care. However, when misused, prior authorization can delay needed medical intervention and result in administrative burdens for providers.

In the 117th Congress, Dr. Bucshon led unanimous passage of the Improving Seniors’ Timely Access to Care Act (H.R. 3173) – a bill that received over 320 cosponsors and the endorsement of over 500 organizations. This legislation would make it easier for seniors to get the care they need and improve health outcomes by modernizing the antiquated prior authorization process in Medicare Advantage, which often still requires faxing documents to insurance companies. Nationally, 28 million seniors are enrolled in Medicare Advantage, including 560,731 in Indiana. 

The bill would:

·    Establish an electronic prior authorization process. 

·    Require the U.S. Department of Health & Human Services (HHS) to establish a process for “real-time decisions” for items and services that are routinely approved.

·    Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials.

·    Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

Congressman Larry Bucshon, M.D. represents Indiana’s 8^th Congressional District in the United States House of Representatives and is a senior member of the House Energy and Commerce Committee.

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