ACR: Prior authorization, fee schedule reform must be Congress’ ‘top priority’
Click Here to Manage Email Alerts
Key takeaways:
- Congress held a hearing on “the collapse of private practice” and obstacles in independent medicine.
- Topics included prior authorization and the Medicare physician fee schedule.
The American College of Rheumatology urged Congress to consider multiple reform agendas, including reforming prior authorization and the Medicare physician fee schedule, after a Capitol Hill hearing on the “collapse of private practice.”
The hearing was held by the health subcommittee of the House Committee on Ways and Means and titled “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine. Five panelists testified, including current and former private practice physicians and operators.
“The American College of Rheumatology is deeply concerned with the many challenges rheumatologists are facing in private practice, including the alarming rate of consolidation and insurance coverage policies designed to block access to necessary health care,” Christina Downey, MD, chair of the ACR’s government affairs committee, told Healio. “Yesterday’s hearing provided an opportunity for policymakers to hear the urgent call for legislative remedies that would address the many issues ailing our health care system and, in turn, our patients.”
Recent years of cuts to the Medicare physician fee schedule took a prominent place in the discussion. Panelists at the hearing repeatedly told lawmakers that updates to the fee schedule “must be the top priority of Congress,” according to a release from the ACR.
“In a time when access to care is already being threatened, patients are increasingly at risk due to the financial pressures from Medicare cuts forcing rheumatologists to severely limit the number of Medicare patients they are willing to care for, opt out of the Medicare program altogether or sell their practices,” Downey said.
The ACR is currently advocating for a bill, called the Strengthening Medicare for Patients and Providers Act, that would “tie the Medicare physician fee schedule to the Medicare Economic Index, a measure of practice cost inflation based on annual changes in physicians’ operating expenses,” according to the release.
Prior authorization was also discussed during the hearing, with panelists requesting that Congress “eliminate the use” of the practice, according to the release. The ACR praised a now-dead bill proposed in 2021 by subcommittee member Rep. Brad Wenstrup, R-Ohio, that aimed “to put guardrails around prior authorization.”
“Prior authorization practices are creating significant barriers to timely and effective patient care,” Downey said. “These burdensome policies not only undermine the medical decisions made by rheumatologists but also endanger patient health.
“Congress must address these issues with immediacy and reform policies that threaten patient access to care and hamstring physicians’ treatment decisions.”
The full 2 ½ hour hearing can be viewed online here.
Collapse
Press Release
Click Here to Manage Email Alerts