The Senate Committee on Finance held a hearing entitled “Bolstering Chronic Care through Medicare Physician Payment” on April 11, focused on forthcoming efforts to reform the Medicare Physician Fee Schedule following a February announcement of a bipartisan working group on Medicare Payment Reform. The members of that working group are Senator Cortez Masto (D-NV), Senator Marsha Blackburn (R-TN), Senator John Thune (R-SD), Senator John Barrasso (R-WY), Senator Debbie Stabenow (D-MI), and Senator Mark Warner (D-VA). The hearing covered a number of important and relevant issues for LeadingAge members.

Chairman Ron Wyden (D-OR) emphasized that he sees this hearing as a kickoff for both the reform of the Physician Fee Schedule and payments to physicians and other providers reimbursed under that schedule—and also as an opportunity for “Chronic 2.0.” He discussed the efforts he led, along with Warner and former Senator Johnny Isakson (R-GA), to conceptualize and pass the Creating High-Quality Results and Outcomes Act (CHRONIC) that was enacted as part of the Bipartisan Budget Act of 2018. Wyden sees changes enabled by the original CHRONIC as jumpstarting the ability of Medicare Advantage (MA) plans to address long-term needs through innovations like supplemental benefits. He also talked about how this work was the initial expansion of telehealth that then exploded during COVID.

When asked about the lessons learned from the MA experience with supplemental benefits, witnesses expressed MA plans have more flexibility to meet patients where they are and provide needed innovations, such as lower cost sharing and transportation services. However, witnesses were much more focused on the downside when related to MA and the physician experience overall—repeatedly saying how prior authorization and other burdens from MA interfere with patient care. For example, a patient who has a controlled chronic condition like diabetes or hypertension may be asked to switch medications because of a formulary. Wyden and others committed to continuing to work on the issues around prior authorization.

Removing cost sharing from services like chronic care management and providing different reimbursement models that allow providers to control the utilization of their time, both clinical and administrative, in a more financially viable way came up multiple times. One witness shared that it takes 50 interactions in three months to coordinate care for some of his chronically ill patients and that the current system does not support this level of complexity.

Warner spoke of his mother’s 11-year journey with Alzheimer’s disease and asked questions about how to reform payment in a way that encourages services that contribute to long-term management of chronic conditions. Witnesses cited the need for value-based care that forces providers to balance clinical needs with cost more effectively, the new GUIDE model focused on dementia care, and the need to support primary care that can coordinate services for these beneficiaries. Warner also asked about the uptake of advanced care planning (ACP), as he worked to secure reimbursement for ACP by introducing the LeadingAge-endorsed Improving Access to Advanced Care Planning Act in the 117^th Congress. Despite efforts to remove barriers to ACP, the witnesses emphasized that while reimbursement is helpful, the administrative burdens of running a practice still take time from patient care.

Senator James Lankford (R-OK) spoke of his experience caring for his mother who had a chronic condition and received mixed messages from her care team about what services she could get on hospice—teeing up questions about reforms to hospice care. LeadingAge’s hospice reform agenda would address some of Lankford’s concerns and we are pleased with his focus and inquiry on the continuum of care concerning chronic disease.

LeadingAge will monitor the Finance Committee’s work on this issue and advocate that they consider our members when thinking about reforms that focus on chronic care.

See a recording of the hearing and download its accompanying materials.