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Docs and DME lose last chance for payment fixes

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Mar 18, 2024
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Illustration: Tiffany Herring/Axios

The absence of health policy riders in the next congressional funding package means some provider groups will likely go without relief until after the election, at earliest.

Why it matters: The minibus was the logical vehicle for additional payment fixes for doctors and durable medical equipment groups, assuming negotiators could find a way to pay for them.

  • But as we scooped over the weekend, the six-bill package won't have health policy changes, because they were deemed too troublesome by congressional leaders.

Between the lines: Rep. Robin Kelly raised the prospect of more physician payment relief last week during a Politico health care summit.

  • One proposal would have adjusted the index Medicare uses to make payments based on the geographic area where a physician works.
  • It would have come on top of a partial payment fix in the first FY24 funding package that reduced a scheduled 3.37% decrease to 1.69% below 2023 payment levels.

Durable medical equipment providers were also hoping lawmakers would use the latest funding package to extend a Medicare blended reimbursement rate of 75/25 for DME in nonrural areas through 2024.

  • One lobbyist for the groups told Axios that without it being addressed, the DME providers will be hard pressed to stay open.

What's next: There are still stand-alone fixes, such as a bipartisan bill that would overhaul the Medicare physician payment system and provide an annual pay increase for doctors tied to inflation.

  • It's sponsored by a group of physician lawmakers: Reps. Larry Bucshon, Mariannette Miller-Meeks, Raul Ruiz and Ami Bera.
  • There's also the DMEPOS Relief Act of 2023 that would provide the 75/25 blended rate in non-rural areas for DME providers. That bill was already approved out of the House Energy and Commerce committee.
  • But absent unexpected developments, providers will pin their hopes on a lame duck session.

What they're saying: "While we appreciate the challenges Congress confronted when drafting the current 2024 appropriations package, we are extremely disappointed that about half of the 2024 Medicare physician payment cuts will be allowed to continue," said American Medical Association president Jesse Ehrenfeld in a recent statement.

  • "Our lobbying team remains fully engaged in working with our champions to identify other options to advance 75/25 provisions in other legislative vehicles, including another government funding package that must pass before March 22," the American Association for HomeCare had previously said in a statement.

The intrigue: The lack of another doctor fix comes at a particularly sensitive time for providers, many of whom are already dealing with massive losses due to the vast-reaching Change Healthcare cyberattack.

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