Top medical groups ask Congress to prioritize Medicare payments, mental health and more

A joint letter from six major medical organizations calls on Congress to ensure patients can access affordable, quality health care.

The organizations — ACP, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Psychiatric Association and the American Osteopathic Association — represent about 600,000 physicians in the U.S.

Physician payments

One prominent issue the organizations discussed in the letter was the Medicare Physician Fee Schedule. The organizations urged Congress to pass the Supporting Medicare

Providers Act, which would prevent an additional 4.47% cut to the Medicare Physician Fee Schedule Conversation Factor for 2023.

They wrote that they are “grateful that Congress acted last year to avert cuts to Medicare physician payments that were scheduled to take effect on January 1, 2022.”

“As you know, these cuts stem from a very complex set of budgetary rules and systemic flaws within the Medicare Physician Fee Schedule that, unless addressed in a comprehensive way, will continue to plague physicians for years to come,” the authors wrote. “As a result, patient access to care is once again threatened as cuts to Medicare payments are poised to take effect at the start of 2023.”

Because the Medicare payment system does not reflect the cost of health care accurately and has not updated physician payment rates to account for inflation for several years, “these challenges are exacerbated further,” they wrote.

The current rates, they wrote, “are not sustainable for physicians to cover the basic expenses of their practice” like rent and maintenance for buildings, payroll for staff and new equipment. Further, they cited an AMA analysis of Medicare Trustees data, which found that, when adjusted for inflation, Medicare physician payment has dropped 20% from 2001 to 2021.

“Unless Congress acts, a continuing statutory freeze in annual Medicare physician payments is scheduled to last until 2026, when updates would resume at a rate of 0.25 percent per year, well below inflation rates,” they wrote. “We urge you to work in a bipartisan fashion to protect Medicare beneficiaries’ access to care.”

Mental health

The letter also referenced the mental health and substance abuse disorder (SUD) crisis, which “requires prompt action by Congress.”

Every year, 20% of Americans face SUD or mental illness, “and many patients are struggling to receive access or timely treatment to behavioral health services.”

“Consequently, we are witnessing staggering rates of suicide, record overdose rates, and increased depression and anxiety across all ages and demographics especially in children and teens,” the authors wrote, noting the “alarming trend of children and teen suicides,” especially in underrepresented populations.

“Unfortunately, many of these mental health challenges are not met with the appropriate resources, which limits patient access and coverage of critical behavioral services,” they wrote.

The letter included recognition and appreciation for the bipartisan effort to address the behavioral health crisis and recommendations to include “critical policies in an end-of-year package to stem the tide of the mental health and SUD crisis in this country.”

They recommended strengthening the behavioral health workforce by increasing graduate medical education for psychiatric residencies funding, enforcing the mental health/SUD parity law, promoting the integration of behavioral health services within primary care, and improving access to qualified mental health professionals and services by increasing funding to mental health and community health centers.

Telehealth

The letter also called on Congress to extend Medicare telehealth flexibilities through Dec. 31, 2024, “including coverage for audio-only services, to ensure beneficiaries can continue to access virtual care and to provide financial stability and regulatory clarity for clinicians.”

The authors wrote that they appreciate Congress’s action to preserve Medicare telehealth access for 151 days past the day the public health emergency expires, but “such a limited extension coupled with ambiguity about when the PHE will end leaves clinicians and their patients in a state of uncertainty.”

“Telehealth has been a lifeline for our physicians and their patients throughout the COVID-19 pandemic, facilitating care continuity while mitigating exposure risks, but the benefits extend beyond pandemic contingencies,” they wrote. “Our organizations support the expanded role of telehealth as a method of health care delivery that can enhance patient-physician collaborations, improve health outcomes, increase access to care and members of a patient’s care team, and reduce medical costs when used as a component of a patient’s longitudinal care.”

They wrote that the recommended extension through 2024 will ensure that people have “the freedom to choose the most appropriate modality of care for their Medicare patients.”

“Additionally, we strongly recommend that additional studies of telehealth utilization and outcomes stratify data by race, ethnicity, language, gender, and other key demographic factors to evaluate whether existing policies are equitably improving access to and quality of care and to inform future legislation to address identified barriers,” they wrote.

Other issues

The organizations also addressed teaching health centers graduate medical education (THCGME) and prior authorization.

The authors stressed the importance of THCGME, noting that residents who received training in THC programs are much more likely to practice primary care (82% vs. 23%); remain in underserved communities (55% vs. 26%); and remain in rural communities (20% vs. 5%).

“This demonstrates that the program is successful in tackling the issue of physician maldistribution and helps address the need to attract and retain physicians in rural areas and medically underserved communities,” they wrote.

The authors asked Congress to extend the THCGME program’s multi-year funding, writing that, “without additional funding by the end of the year, we have grave concerns for the financial stability of programs for the upcoming year” and “flat funding in a continuing resolution in October 2023 would mean a 40-50 percent reduction in per resident allocation for teaching health center programs, putting them at risk of closure.”

As for prior authorization, the authors called on Congress to “complete its work on H.R. 3173, the Improving Seniors' Timely Access to Care Act,” which “will help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program.”

“Today, nearly half of Medicare eligible beneficiaries are enrolled in MA plans,” the authors wrote. “These plans have prior authorization approval procedures that needlessly delay care for patients and are overly burdensome for physicians. Prior authorization requirements often delay patient care, which can be a life-or-death situation for people with serious diseases. They also force physicians to take time away from patient care and are costly for medical practices.”

According to the organizations, these issues “are of great concern for all patients, especially those with serious health conditions for whom delays in care are most dangerous.” They can also affect physicians, being “particularly burdensome for smaller physician practices that may not have the staff or structure to address the additional administrative work, potentially impeding access to care in underserved areas with clinician workforce shortages.”