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 operating out; among the many points being resolved at this late second are questions across the extension of telehealth flexibilities, various fee mannequin reimbursement ranges, and managed care prior authorization rules.
As has change into a routine factor of Congressional operations, the U.S. federal authorities is being funded by means of Persevering with Decision (CR) appropriations reasonably 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 meanwhile. And, it is very important 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 signify a combined bag for medical teams,” stated Anders Gilberg, senior vice chairman, 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 means of the top of 2026, improve APM incentive funds to three.53%, and lengthen the 1.0 Medicare work GPCI ground. These are huge wins for medical teams. However, we’re deeply upset that Congress failed to completely treatment the looming 2025 Medicare fee reduce to doctor practices. Any reduce, nevertheless fractional, is unacceptable. Lastly, not together with laws to reform prior authorization, which has the assist of a bipartisan majority of the Home and Senate, practically 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 large insurance coverage to the detriment of America’s sufferers.”
In the meantime, Aisha Pittman, senior vice chairman 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 stated on Thursday night time that “The Nationwide Affiliation of ACOs (NAACOS) commends Congress for together with an extension of the Superior Different Cost Mannequin (APM) incentive at 3.53 p.c within the Additional Persevering with Appropriations and Catastrophe Reduction Supplemental Appropriations Act, 2025. This crucial incentive empowers clinicians to drive innovation in well being care whereas enhancing affected person outcomes and lowering prices. We additionally respect lowering the cuts to doctor fee by 2.5 p.c, a step towards guaranteeing clinicians are adequately compensated and motivated to embrace value-based care.”
Additional, Pittman stated, “Worth-based care is reworking well being care supply by prioritizing prevention, enhancing care coordination, and increasing entry to companies past these historically coated by Medicare—all of which contribute to protecting sufferers wholesome and extra environment friendly techniques. It’s crucial to create pathways for all clinicians to take part in APMs that liberate suppliers from the constraints of the fee-for-service mannequin and give attention to worth over quantity. NAACOS seems to be 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.
It is a growing information story; we are going to publish updates as new developments warrant.