At the same time as 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 working 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 laws.
As has develop into a routine component of Congressional operations, the U.S. federal authorities is being funded by Persevering with Decision (CR) appropriations relatively 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 intervening time. And, you will need to notice, last-second modifications to the draft CR produced within the Home of Representatives on Thursday afternoon are nonetheless potential.
“The well being provisions within the proposed CR symbolize a combined bag for medical teams,” mentioned 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 the tip of 2026, improve APM incentive funds to three.53%, and prolong the 1.0 Medicare work GPCI flooring. These are massive wins for medical teams. However, we’re deeply disillusioned that Congress failed to totally treatment the looming 2025 Medicare fee minimize to doctor practices. Any minimize, nevertheless fractional, is unacceptable. Lastly, not together with laws to reform prior authorization, which has the help of a bipartisan majority of the Home and Senate, almost 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 giant 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 mentioned on Thursday night time that “The Nationwide Affiliation of ACOs (NAACOS) commends Congress for together with an extension of the Superior Various Cost Mannequin (APM) incentive at 3.53 % within the Additional Persevering with Appropriations and Catastrophe Aid Supplemental Appropriations Act, 2025. This crucial incentive empowers clinicians to drive innovation in well being care whereas enhancing affected person outcomes and decreasing prices. We additionally admire decreasing the cuts to doctor fee by 2.5 %, a step towards making certain clinicians are adequately compensated and motivated to embrace value-based care.”
Additional, Pittman mentioned, “Worth-based care is remodeling well being care supply by prioritizing prevention, enhancing care coordination, and increasing entry to providers past these historically coated by Medicare—all of which contribute to retaining sufferers wholesome and extra environment friendly programs. 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 deal with worth over quantity. NAACOS seems to be ahead to working with Congress to craft a sustainable, long-term method to doctor fee reform that helps the transition to high-value, patient-centered care,” she added.
This can be a growing information story; we’ll publish updates as new developments warrant.
