In the News

It's "appalling" that Congress has yet to reduce or repeal the reimbursement cuts in the Medicare Physician Fee Schedule, Rep. Larry Bucshon, MD, said here Tuesday at the American Medical Association (AMA) Advocacy Conference.

"It's like $1.2 billion to fix this for a year," said Bucshon (R-Ind.) during a question-and-answer session. "I mean, it's a rounding error. I'm honestly appalled that Congress won't fix this."

In November, CMS finalized a nearly 3.4% cutopens in a new tab or window in physician payments for 2024, which took effect on Jan. 1. Several bills have been introduced to either reduce or eliminate the cut, but nothing has yet been passed.

"In the immediate term, we need to fix this," Bucshon, who recently announced that he is not running for reelection, said during a speech to conference-goers. "And I'm working hard on it. We are interacting with leadership on both sides. I think we'll get most of those cuts mitigated, either at the end of this month or in March" when the short-term spending bills passed by Congress to keep the government funded will expire.

In the longer term, "we need bigger changes" in physician reimbursement, he continued, adding that although he himself had proposed giving physicians a 1-year pay increase based on the increase in the Medicare Economic Index -- a measure of healthcare inflation -- "we know that needs to be more firm." Bucshon also is cosponsor of the Preserving Seniors' Access to Physicians Actopens in a new tab or window, which would effectively zero out the Medicare cut, but would not increase physicians' pay. "It's an 'all the above' approach," he said. "We're tackling this from many fronts."

Another payment area needing improvement is the Medicare Access and CHIP Reauthorization Act (MACRA), Bucshon said, noting that he led a bipartisan request for information in late 2022 so stakeholders could give their opinions on how MACRA should be reformed; the lawmakers are still reviewing the responses.

"Until policy changes are enacted to address the growing chasm between Medicare reimbursement rates for physicians and the real costs of running a practice, the challenges facing America's physicians will worsen," he said. "Ultimately, the consequences will undermine patient access to care, accelerate provider consolidation, and intensify the physician and healthcare workforce shortage that is already threatening many communities."

Bucshon also criticized the methodology used by the Congressional Budget Office (CBO) for projecting the costs of various bills, especially those involving spending for preventive care. The CBO can only project costs and savings for a maximum of 10 years, and "I think all of us know the benefits ... are many years down the line. You control their diabetes, their high blood pressure, their obesity issues, and it saves you money down the line. And it's not just saving money -- it makes people's lives better. People are healthier and more productive, and live longer." Bucshon is a cosponsor of the Preventive Health Savings Actopens in a new tab or window, which would require the CBO to look beyond 10 years for savings in preventive health legislation, and include such savings in their analyses.

Prior authorization is another issue of concern. Bucshon is a cosponsor of the Improving Seniors' Timely Access to Care Actopens in a new tab or window -- which would require affected health plans to establish an electronic prior authorization process and issue real-time decisions on routinely approved services and procedures. "Prior authorization is a big issue for all of us ... We need to do something about it," he said. However, the prior authorization bill was recently upstaged by CMS which issued a final ruleopens in a new tab or window that would accomplish many of the provisions in the bill. As a result, "we're currently working to fine tune language of an updated bill," said Bucshon.

But both the CMS rule and the prior authorization bill only apply to government-funded health plans such as Medicare, Medicaid, and CHIP. Getting prior authorization rules that would apply to employer-sponsored plans "is a tougher nut" to crack, Bucshon told MedPage Today in an interview. "When you start talking about totally private sector plans and whether there should be intervention there ... I think there need to be some stricter standards, but it's a higher hill to climb when you start talking about [employer-sponsored] ERISA [Employee Retirement Income Security Act] plans and those type of things."

Bucshon also expressed concerns about violence in healthcare facilities, citing a Bureau of Labor Statistics report showing that healthcare workers are five times more likely than any other type of employee to be assaulted on the job. "COVID brought this to the forefront," he said. "We're seeing more and more issues with violence against healthcare workers. There is currently no federal law that affords doctors and other professionals protection from intimidation across the healthcare system."

Last April, Bucshon introduced the Safety from Violence for Healthcare Employees (SAVE) Actopens in a new tab or window, which would establish a federal criminal offense for anyone assaulting or intimidating hospital workers in a way that interferes with their work. The bill, which has a companion in the Senate, also would authorize grant funding to reduce violence at hospitals. "Healthcare heroes across the country that worked through COVID deserve a workplace free from violence," he said, while admitting that the measure is a heavy lift because it involves federalizing a criminal offense.

"We have people in Congress on both sides of the aisle that really believe this is a local or state offense: 'We don't want to bring in the Feds here,'" Bucshon said. "And so that's been the [big] barrier."