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Physician Policy Issues By Kim Monk, Rob Smith Politics and policy mandates from Washington, D.C. may feel like they exist in a parallel dimension to the daily experience and careers of healthcare professionals, but every regulatory decision, billing code or clinical approval process began as a policy proposal inside the beltway. The range of legislative and regulatory issues impacting physicians’ practices are widely varying and constantly in flux. Congress and agencies like CMS tend to be driven by catalysts that force action. Here we will distill the major issues currently under debate and identify the most important upcoming catalysts. For instance, regulatory flexibility around telehealth, scope of practice, free COVID tests and treatment, and continuous Medicaid coverage will expire at the end of the Public Health Emergency (PHE) barring action by Congress to make some of these flexibilities permanent. We think HHS is unlikely to end the PHE before at least early 2023. Although the agency has started taking substantial steps to wind the emergency down, it’s going to be a very complicated process, and Congress has done little to ensure favorable waivers for telehealth, scope of practice expansion, and other policies will be made permanent. Telemedicine: Good news—unlikely that Congress will greatly curtail the expansion as a result of COVID. Bad News—it is going to be some time before regulators will have sufficient confidence to make any permanent decisions. For telemedicine, we think it will likely take several years of data analysis and policy development before legislation is enacted to provide stable coverage and reimbursement. Currently, CMS’ telehealth emergency
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waivers will be extended for five months after the end of the PHE under legislation enacted earlier this year. We think several more temporary extensions will be necessary until Congress agrees on a permanent policy.
rate updates for 2023. However, relief for some specialty groups from reimbursement cuts stemming from updated E/M and clinical labor policies will require action from Congress, which is far from certain at this point.
Reimbursement: Moving on and with a greater awareness of the value of medical workers. Congress is quickly closing its COVID wallet, and further relief from the 2% Medicare sequester or replenishment of the provider relief fund are unlikely to pass despite strong lobbying from AMA, AHA and other provider groups. Increasing medical inflation is likely to lead to favorable CMS physician
Coverage: BBB is dead but ACA is setting up to come back to life as an election battleground. Although the BBB may be dead, health coverage remains a huge priority for Dems, which is why we think they will use the reconciliation vehicle to extend the enhanced ACA tax credits, presumably paid for with drug pricing reforms. The end of the PHE will also kick off a massive effort by states to
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