Telehealth gets short extension, physician pay is cut in spending bill

Photo: Jeremy Walke/Getty Images

President Joe Biden on Saturday signed a spending bill that averts a government shutdown, but some healthcare provisions that were in the original bill didn't make it to final passage.

Acute hospital-care-at-home and telehealth temporary waivers were continued, but were not given the long-term extensions that were included in a Dec. 18 bipartisan resolution. Both received short-term extensions until March 31.

The original bill extended telehealth for two years and acute hospital care at home by five years.

Stripped out of the bill is a provision to prevent the Medicare pay cut to physicians. This means physicians get a 2.8% Medicare payment cut on January 1, 2025. 

"When medical practice inflation is factored in, this is in effect a 6.4% payment cut to physicians," the California Medical Association said.

The American Medical Association said Congress failed patients and physicians. AMA President Dr. Bruce A. Scott said, "The Continuing Resolution utterly fails to address declining reimbursement rates for Medicare, pushing our health system down a path that will have predictable and deleterious results. For the fifth consecutive year, Congress has adjourned and allowed Medicare cuts. What will be the result? Patients struggling to access healthcare. Physicians closing or selling their private practices while others opt to leave the profession."

The Medicare Payment Advisory Commission recommended a permanent, inflation-based update, but Congress didn't do that, the AMA said. The cost of delivering care rises 3.5% next year, Scott said. 

MGMA's SVP of Government Affairs Anders Gilberg called the final Continuing Resolution "a huge congressional failure to the detriment of the nation's Medicare patients and their physicians. The previously agreed-upon CR, while not perfect, would have critically averted most of the 2.83% cut to physician reimbursement in Medicare beginning January 1. Now physician practices head into the new year facing uncertainty and financial shortfalls that not only negatively impact the viability of their Medicare business, but their commercial contracts tied to Medicare rates, as well as Medicaid reimbursement in states that use Medicare as a benchmark."

WHAT ELSE IS IN, WHAT'S OUT:

The final package also left out prior authorization reform, which had bipartisan support, the AMA said. 

"Leaving it on the cutting room floor is an unnecessary gift to the insurance industry at the expense of our patients," Scott said.

New regulations that would have targeted pharmacy benefit managers were cut. 

Congress did avert $8 billion in Medicaid disproportionate share hospital cuts by eliminating scheduled payment cuts for these hospitals that treat a large number of vulnerable patients. 

Patients For Affordable Drugs Now expresses deep disappointment and frustration over the failure to include key drug pricing reforms in the end-of-year continuing resolution despite strong bipartisan support. 

THE LARGER TREND

The U.S. House of Representatives overwhelmingly (366-34) passed a stopgap bill on Friday to keep the government funded until March 14, 2025. 

It moved to the Senate where early on Saturday in an 85-11 vote, the spending bill was approved.

The bill includes $100 billion in disaster aid and $10 billion in economic aid for farmers. but not the debt limit extension as requested by President-Elect Trump, according to The Wall Street Journal.

The bill marked House Speaker Mike Johnson's third attempt to combine a three-month funding extension with emergency aid, after wrestling with competing demands from President-elect Donald Trump, his billionaire efficiency czar Elon Musk, internal GOP critics and Democrats, the WSJ report said.

Email the writer: SMorse@himss.org