In 2021, ACP advocacy efforts led to regulatory relief and financial assistance, initiatives to advance the value of internal medicine, and efforts to promote diversity, equity, and inclusion
Jan. 7, 2022 (ACP) – Practices continued to face unprecedented challenges, upheaval and uncertainty in 2021 due to the ongoing COVID-19 pandemic, and the American College of Physicians stepped up efforts to help doctors navigate these rocky waters and chart a course to the future.
Everyone had high hopes that COVID-19 would lose its hold by late 2021, but the advent of the delta and omicron variants along with the ongoing need to build vaccine confidence and other issues have proven that this virus is still formidable, explained Shari Erickson, ACP interim senior vice president for governmental affairs and public policy.
“Practices took huge hits in terms of reduced visit volume early on, leading to our advocacy for ensuring that they could effectively conduct telehealth and audio-only visits with their patients and be paid appropriately, at parity with in-person visits,” she said. ACP efforts helped to extend some of the telehealth flexibilities beyond the public health emergency.
ACP also advocated for significant regulatory relief and financial assistance and helped ensure that members had access to personal protective equipment to safely conduct in-person visits throughout 2021, Erickson said. ACP also called for COVID-19 vaccine mandates for all health care workers, employers and schools.
This advocacy has been paired with tools to help members implement needed changes in their practices, such as COVID-19-specific coding and billing, telehealth implementation, and payer policies, which have continued to evolve and change. Other ACP-developed tools are aimed at managing supplies and testing; practice financial assistance, including how to access payroll assistance loans; fostering well-being; and mitigating burnout, Erickson said.
“All of these activities together are critical to ensure that our members can continue to practice in safe, efficient and effective manners throughout the rest of this pandemic and beyond,” she said.
Championing Primary Care
In 2021, ACP championed initiatives to advance the value of internal medicine and primary care by sponsoring the National Academy of Sciences, Engineering and Medicine report on high-quality primary care; cofounding the Primary Care for America campaign, a collaboration that aims to demonstrate the value of primary care; developing a new unified vision for changing primary care finance in collaboration with a number of other primary care-focused organizations; and continuing to work with the Primary Care Collaborative.
ACP encouraged Congress to pass legislation to avert the bulk of the 9.75% projected reimbursement cuts in the Centers for Medicare & Medicaid Services (CMS) 2022 Medicare Physician Fee Schedule Final Rule, which were slated to take effect on Jan. 1, 2022. On Dec. 10, 2021, President Biden signed the Protecting Medicare and American Farmers from Sequester Cuts Act, which delayed these cuts. “Thanks to our work with Congress and the outreach by ACP's grassroots members, we were able to avert these cuts,” Erickson said.
ACP worked to make sure critical care codes can be billed on the same day as evaluation and management services and not be bundled with global surgical fees, and provided significant input into a relevant Merit-based Incentive Payment System (MIPS) Value Pathway available in 2023 focused on chronic disease management.
Other federal programs reflected ACP recommendations, including improvements to the Affordable Care Act (ACA) through the extension of subsidies for people with lower income levels so that they can afford to buy coverage, Erickson noted.
Advancing DEI in Health Care
ACP doubled down on its commitment to combat racial disparities and promote diversity, equity, and inclusion in medicine in 2021, and ACP plans to continue advancing these efforts in 2022 and beyond.
“We are committed to finding evidence-based solutions to promote diversity, equity and inclusion across the full spectrum of the health care system, as well as in law enforcement and criminal justice, which also affects the health of at-risk populations,” Erickson said.
These efforts included the development of “A Comprehensive Policy Framework to Understand and Address Disparities and Discrimination in Health and Health Care,” an in-depth policy that discusses the interconnected and compounding aspects of society that contribute to poorer health outcomes for persons based on their race, ethnicity and religious and/or cultural identities.
Looking Ahead to 2022
ACP's 2022 advocacy plan is already taking shape.
“While COVID-19-related issues will remain on our agenda, including continued advocacy related to COVID-19 vaccination mandates, we will continue to fight for other issues like expanding patient access to health care through ongoing improvements to the ACA and even potentially via a public option, as laid out in our New Vision for Health Care,” Erickson said. (Published in January 2020, the New Vision for Health Care spells out the ACP Vision for the U.S. Health Care System.)
“We will also continue to seek pay parity in reimbursements for Medicaid with Medicare services, given that Medicaid payment still lags far behind Medicare in many parts of the country,” Erickson said.
ACP is also prioritizing improvements to the overall physician payment and delivery system within Medicare and beyond for 2022. “The Medicare budget neutrality issues that led to the potential cuts in those payments in 2022 need to be addressed in a more comprehensive manner moving forward, ideally with an eye toward moving to value-based alternative payment models rather than continuing a reliance on fee-for-service,” Erickson said, noting that this calls for reforming aspects of the Medicare Access and CHIP (Children s Health Insurance Program) Reauthorization Act (MACRA).
By way of background, MACRA is intended to shift physician payment so that it rewards value and quality over volume via the creation of the Quality Payment Program (QPP). The QPP offers two pathways for reimbursement: MIPS and Advanced Alternative Payment Models.
Women's health also remains a big focus for 2022, Erickson said. “The coming year will bring about new challenges due to the women's reproductive health cases before the Supreme Court and other similar cases across the country,” she said, “and we will also be advocating for legislation to address issues that women face in terms of domestic violence and dating abuse.”
An infographic, “2021 ACP Advocacy Highlights,” can be viewed on the ACP website.
Back to the January 7, 2022 issue of ACP Advocate