College shares ideas on ways to control costs but also improve the quality of health care
March 22, 2019 (ACP) – When a U.S. Senate committee asked the health care community for ideas on how to lower health care costs, the American College of Physicians was quick to respond.
In an 18-page statement, ACP focused on ways to not just lower costs, but to improve access to care and the overall quality of health care, including strategies to bolster the primary care workforce and reduce the administrative burdens faced by physicians. The recipient of ACP's suggestions – the Senate Committee on Health, Education, Labor and Pensions (HELP) – will recommend courses of action to the full Senate.
High on the list of ACP's suggestions is the renewal, and in some cases the increase, of funding for three programs set to expire at the end of fiscal year 2019. These include the National Health Service Corps, a program that encourages primary care doctors to train in underserved areas by offering scholarships and loan repayment.
“These clinicians tend to stay in those areas after their obligation is over, and it is vital that this program moves forward without disruption,” said Jared Frost, ACP's senior associate for legislative affairs. Research has shown that patients fare better when a primary care doctor is involved in their care, and the current dearth of primary care doctors is expected to worsen, according to the Association of American Medical Colleges.
ACP also urged continued funding for the Teaching Health Centers Graduate Medical Education Program, which provides funding for primary care residents in community settings, and the Patient-Centered Outcomes Research Institute, which funds evidence-based research.
“The funding for all three programs was authorized for a set period of years and now is expiring unless Congress acts,” Frost said.
ACP's input also included suggestions in line with its key advocacy initiative of putting patients before paperwork, starting with the issue of prior authorization, which Frost described as one of ACP members' greatest pain points when it comes to administrative burdens.
“We would like to reduce that burden on physicians by minimizing these requirements,” he said. “But even if it is not possible to do away with prior authorizations altogether, a standardized form would be beneficial so physicians don't have to fill out different forms for the same outcome.
In addition, ACP stressed to the committee the need for prompt development of more advanced alternative payment models (APMs), which promote high-quality, cost-efficient care. ACP noted how participation in APMs is critical to the transition to value but has been behind projections due in part to the limited availability of APM options. Eight national models currently qualify as Advanced APMs under the Quality Payment Program and only one has been added since the start of 2017.
ACP urged the Centers for Medicare and Medicaid Innovation (CMMI) to give more earnest consideration to private sector physician-led models recommended by the Physician-Focused Payment Model Technical Advisory Committee (PTAC), of which none have been taken up out of more than a dozen recommended. ACP teamed up with the National Center for Quality Assurance to submit its own Medical Neighborhood Model for consideration by the PTAC last fall and is currently working to refine technical elements of the proposal so that it can be formally considered by the committee and voted on this year.
“These models present a real opportunity to meaningfully improve care for patients and achieve savings for the health care system,” ACP told the committee.
“The lack of APMs to participate in is a big concern, and we would like CMS and Congress to work to increase eligibility and availability of APMs,” Frost said. Participating physicians also “need to be reassured that the promised 5 percent lump-sum bonus will be continued beyond 2022,” he added, noting that funding for the bonus is set to expire at the end of the 2022 without further Congressional intervention.
In its statement, ACP also urged the committee to:
- Take steps to reduce the cost of prescription drugs. Specific suggestions included preventing practices that impede generic drugs from making it to the marketplace, such as extended data exclusivity for biologics, and increasing transparency on research and development costs.
- Improve access to care. Suggestions included stabilizing the health insurance marketplace to preserve health care coverage and maintaining certain protections established by the Affordable Care Act, including one that prohibits insurance companies from denying or discontinuing coverage to people with pre-existing conditions.
- Put an end to Medicaid work requirements. At least 15 states are seeking approval for policies that would require people to be employed in order to qualify for Medicaid benefits. ACP told the committee that “work requirements are inconsistent with the mission and purpose of the Medicaid program” and would result in a greater number of uninsured Americans. The College added that such requirements would “impose an unnecessary and unjustified burden on patients to document that they are eligible for an exemption and an unnecessary and unjustified burden on physicians who may be asked to attest that their patients have an exempted medical condition.”
“We are extremely encouraged that the HELP Committee is looking at these issues, [and] we are hopeful that they will move the needle on some of these issues this year,” Frost said. But, he acknowledged, “it's a long-term process.”
ACP's full response to the Senate HELP Committee's request for suggestions on reducing health care costs is available on the College's website.