2023 was a year of wins with implementation of the G2211 code, launch of the ‘Making Care Primary’ model, extension of telehealth flexibilities and more
Jan. 12, 2024 (ACP) -- The American College of Physicians made progress on several key advocacy issues in 2023, from doubling down on efforts aimed at putting patients before paperwork to championing telehealth in the post pandemic era and taking steps to reduce firearm injuries and death.
In 2023, ACP identified policy solutions to help simplify the prior authorization process and increased the number of cosponsors for the Safe Step Act, a bill that would require a group health plan to establish a transparent exception to medication step-therapy protocols in specified cases. This bill, which has bipartisan support in the Senate and House, may be passed in 2024.
“Through grassroots efforts, we achieved a 127 percent increase in House support for the Safe Step Act after Leadership Day in 2023,” said Shari Erickson, ACP chief advocacy officer and senior vice president. Leadership Day is the annual two-day ACP advocacy event in Washington, D.C., when members talk to U.S. lawmakers about key advocacy issues affecting patients and physicians.
ACP played an integral role in encouraging UnitedHealthcare to pull back on prior authorization changes that would require physicians and patients to get prior approval for nearly all gastroenterology procedures or potentially face paying out of pocket. Instead, the insurance company is now requiring that it receive advance notification in lieu of prior authorization.
In another ACP-supported win for patients and physicians, the Centers for Medicare & Medicaid Services announced that Medicare will be able to negotiate prices directly with drug companies, lowering prices on prescription drugs, according to Erickson.
ACP advocacy also played a role in implementation of the G2211 code, which applies to more complex, continuous primary care. “This will be helpful to our members, who regularly provide this type of care but are not adequately paid for it,” Erickson said.
ACP worked to ensure that telehealth will still be covered in 2024 and beyond and that there would be a delay in requiring in-person visits for behavioral health care. “We did learn through COVID-19 that good care can be provided through telehealth,” Erickson said.
CMS launched “Making Care Primary” in 2023, and this new value-based payment model helps better support primary care physicians and reflects many of the key elements that ACP proposed in the Medical Home Neighborhood model.
ACP was also active in the public health arena in 2023, with the launch of a national campaign calling for policies to reduce firearms-related injuries and deaths and with advocacy for policies to protect patient access to reproductive health services and gender-affirming care.
Combatting structural racism and addressing social determinants of health have long been advocacy goals for ACP. In a new policy paper, ACP highlighted the importance of ensuring equitable access to the electoral process at the tail end of 2023. In the paper, ACP states that low voter turnout and inequitable electoral structures, including gerrymandered districts, can further exclude individuals and communities that have been historically marginalized.
“It will be an election year, so we will ramp up efforts so our members and patients will have the opportunity to access the electoral process,” Erickson noted.
Although it was a productive year, Erickson said there is still a lot of work to be done in 2024.
For starters, due to budget neutrality requirements, Medicare physician payments have been cut by 3.4 percent as of Jan. 1, 2024. However, Congress can step in to cancel this cut as part of the appropriations bills that must be passed by Jan. 19, 2024 in order to avert a partial government shutdown. ACP has sent out action alerts to members to urge Congress to cancel the cut.
Other issues that top the ACP advocacy list for 2024 include lobbying for Medicaid unwinding to occur in a transparent and accountable manner, without wrongful coverage terminations; supporting behavioral health integration into primary care models; helping members with inbox management and ensuring interoperable electronic health record systems; and tackling budget neutrality, a policy that requires any significant increase (greater than $20 million) in the relative expenditures in one area of the Medicare Physician Fee Schedule must be offset by an overall reduction in payments to physician services by that excess amount.
“Enhancing the physician workforce will also be one of our top priority areas,” Erickson said. “We will try to improve access to primary care through various policies and advocate for greater training of physicians in ambulatory environments outside of the hospital in 2024.”
An infographic, “How ACP Advocated for You in 2023,” can be viewed on the ACP website.