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Nov 20, 2023

Contact: Grant Herring

Momentum Builds Behind H.R. 3674

Key legislation considered during House Energy and Commerce Committee markup

Washington, DC — Last week, the Providing Relief and Stability for Medicare Patients Act of 2023 (H.R. 3674), legislation to strengthen community and office-based providers, was considered during the Energy and Commerce Health Subcommittee markup held on November 15.

H.R. 3674 is bipartisan legislation that aims to stop ongoing cuts to office-based specialists for the next two years. By doing so, it helps prevent major disruptions in patient access to care while addressing concerns about the future of Medicare physician payments. Watch the explainer video on H.R. 3674 HERE.

E&C Health Hearing Highlights

Congressman Gus Bilirakis (R-FL-12) Transcript:

Rep. Bilirakis:

Thank you, Mr. Chairman. I appreciate it very much. I first want to say I'm fully supportive of the underlying bill, H.R. 6371, which will help provide additional stability for providers under the Medicare fee schedule. This bill will accomplish this by raising the budget neutrality threshold, requiring CMS to continue to update the direct costs relative value units and adjust pricing and limiting the damage of the conversion factor each year. I want to thank my good friend, Dr. Burgess. We're going to miss you, doctor, but I know we have a few more months left. My bipartisan amendment, which I do plan to withdraw, Mr. Chairman would insert a new section with the contents of my bipartisan bill, H.R. 3674, The Providing Relief and Stability for Medicare Patients Act, which was noticed in our last subcommittee legislative hearing in October. Of course, I'm disappointed, but I know there's another day there that we were unable to get it on the agenda to mark it up and move forward here today.

H.R. 3674, which I lead with my good friend, Representative Cárdenas, would mitigate payment cuts to specialty services provided in community office-based physician practice settings. These non-facility settings help preserve patient access to care and avoid further consolidation in the Medicare program. Office-based specialty care is a critical service outside of the hospital setting. It is also less costly for Medicare and for patients than when such care is provided in more expensive hospital settings. It's a win-win for everyone, and I hope we get this done. However, and it's 2022 Physician Fee Schedule CMS finalized an update to its clinical labor policy and due to budget neutrality constraints led to significant Medicare cuts for office-based specialists, such as radiation oncologists, vascular surgeons, nephrologists, urologists and many others. These adjustments and clinical labor costs meant some providers faced over 20% cuts in reimbursements, that's unsustainable, resulting in some physicians discontinuing their services. Very unfortunate to the patients, leaving the field through retirement or consolidating their practices to large systems or private equity interests.

Patients are ultimately hurt by these effects due to lack of access to specialty care services in their communities and worse, health disparities for rural and underserved areas. I represent plenty of rural areas in my new district, Mr. Chairman. My bill would provide two years of targeted relief for specialty care providers who were most adversely impacted by this policy starting in 2024 and continuing through 2025. Unfortunately, if we don't act soon, the next round of cuts will lead to more consolidation and I fear worse outcomes for patients who will pay more and wait longer for their care. We should be doing all we can to prevent this in our healthcare system. I understand that the cost associated with our bill may need to be scaled back, and I am committed to finding a path forward that ensures that the bill is fully offset. This includes potential ways to reduce the percentage of practice expense, RVUs applied within the bill.

In fact, our legislation was designed in a way to ensure these dials can be controlled in a way that is fiscally responsible. I want to thank Representative Cárdenas for supporting these efforts with me and co-sponsoring this amendment. I also want to recognize Dr. Murphy and Representative Davis on the Ways and Means Committee. I also know that Senator Tillis offered the amendment as well on the Senate Finance Committee last week. So Mr. Chairman and Madam Ranking Member, I ask that you both please commit to working with me and the other co-leads on this bill to advance this policy further and ensure office-based specialists have stability under the Medicare program. These cuts must be mitigated to allow our doctors to continue to provide great care for patients and our community. So I can't emphasize this enough. I've talked to many, many doctors, and this needs to get done, so we really would appreciate your considerations.

Rep. Bilirakis: Yes, thank you, Mr. Chairman. I know you'll work with me on this particular bill.

Rep. Bucshon (R-IN-8) Vice Chair of the E&C Health Subcommittee: Oh, yeah.

Watch the exchange here.

Congressman Tony Cárdenas (D-CA-29) Transcript:

Rep. Cárdenas:

I would like to thank my colleague, congress, for bringing forth this amendment, which will be hugely consequential for access to care in community settings. If we are serious about ensuring greater accessibility to healthcare services, we have to address the systematic under reimbursement for care provided in office-based settings. Office-based specialty care is often a lifeline for patients with a range of conditions, including those with cancer and end-stage renal disease, peripheral artery disease, and others. All of these conditions pose a major risk to constituents in my district, and what is more challenging is that these office settings are facing potential closures or consolidation into larger systems because of cuts.

My concern is that closures and consolidation reduce options, creating unnecessary barriers for people seeking needed care. The local clinics will close and patients' access will suffer if this goes unaddressed. I hope that my colleagues agree to work on this legislation and to land on a path forward that supports access to community care. We stand ready to collaborate on this, many of us do.

Lastly, before I conclude, I also want to mention that I'm grateful for some of the other amendments being proposed today, which look to fix some of the structural concerns with physician reimbursement. I hope to continue to engage on these issues as we go forward. Failing to do so will contribute to already shocking rates of physician shortages and reduces access to care for patients.

Watch here.

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