Capitol Insights Newsletter

Authors: Luke Schwartz & Matt Reiter

What happened in Congress this week?

On Wednesday, May 1st, the Senate Finance Committee and the House Energy & Commerce Subcommittee on Investigation & Oversight held hearings with UnitedHealth Group (UHG) CEO Andrew Witty. The featured topic will cover these hearings and their implications.

This week the Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing on the shortage of minority healthcare professionals and the maternal health crisis. Panelists, including two members of Congress, made statements, and answered questions from committee members on actions that can be taken to address these issues. The solutions mainly focused on expanding medical education opportunities for minority communities at colleges and universities, addressing unique health issues facing minority populations, and expanding prenatal and postpartum care as a way to achieve better health outcomes for new moms.

Senate Budget Committee Holds Hearing on Reducing Physician Administrative Burden

On Wednesday May 8th, the Senate Budget Committee held a hearing titled “Reducing Paperwork, Cutting Costs: Alleviating Administrative Burdens in Healthcare.” The session featured testimony from three witnesses addressing the excessive spending on administrative tasks in the United States healthcare system. According to hearing witness Harvard Professor Dr. David Cutler, one-quarter of healthcare expenditures are consumed by administrative processes rather than direct patient care. The lack of standardization among insurers exacerbates the already high administrative burden on physicians. This burden, coupled with low reimbursement rates and the time spent on paperwork instead of patient care, is contributing to physician burnout, further straining an already overstretched healthcare system. 

Reforming prior authorization was the most discussed policy on how to alleviate the administrative burden on physicians. Witnesses emphasized that these policies undermine the ability of physicians to determine the appropriate treatments for their patients. Throughout the hearing, there were examples cited by witnesses and senators that illustrated cases where patients were denied essential care due to delayed or denied prior authorization. 

There was a large focus on the high amounts of prior authorization present in Medicare Advantage (MA). To this end, Senator Roger Marshall (R-KS) shared his plan to reintroduce the Improving Seniors’ Timely Access to Care Act in June. This bill would establish several standards and requirements impacting prior authorization in MA plans to ensure Medicare beneficiaries can access care when they need it.

The Centers for Medicare and Medicaid Services (CMS) recently finalized a regulation that implements most of the policies of this bill. Passing this bill will codify these changes which will provide greater certainty that they will remain in place. While the bill has enjoyed enormous bipartisan support, the Congressional Budget Office (CBO) projected it would cost as much as $16 billion over ten years. The cost has prevented the bill from passing. Now that the CMS final rule is in place, the CBO revised its score to estimate that the bill will not have any impact on the budget deficit. This new score should make it easier for Congress to pass this important bill.

One policy recommendation suggested by the witnesses to address the numerous hurdles of prior authorization is to conduct annual “spring cleanings” of the CPT coding system by removing outdated medical codes. Currently, the system contains over 11,000 procedure codes. According to the witness, half of these codes are not widely used. According to the witness, this could help streamline the prior authorization process and lessen the burden on physicians. 

AI was another important discussion topic. While the emergence of AI can be an asset to alleviating physician burden if used properly, members and witnesses pointed to its drawbacks as well. For example, many are upset that insurance companies are employing AI to automatically reject claims, leading to headaches across the industry.  

Another topic of the hearing was Value-Based Care (VBC). Some senators and witnesses pointed to VBC as an alternative to the traditional fee-for-service model to reduce physician burden.

In conclusion, there was wide bipartisan agreement that the high administrative burdens on physicians need to be addressed immediately to prevent physician burnout while ensuring money is spent efficiently in the health sector, where the US spends significantly more than any other country per capita.  

Top Stories in Healthcare Policy

CMS is extending the time states have to fully “unwind” their Medicaid programs until June 30, 2025. This gives states more time to verify Medicaid eligibility for all of their Medicaid beneficiaries.

CMS is planning to increase cybersecurity requirements for hospitals. This could be a first step towards expanding cybersecurity requirements throughout the healthcare system.

 State lawmakers across the country are voting to ban or limit noncompetes at the state level for certain doctors and healthcare professionals. There is much concern that the FTC’s recent Final Rule banning noncompetes in most cases will be blocked.

Senator Cassidy called on the Biden Administration to offer more transparency surrounding its gathering of scientific evidence on the outbreak of the Avian Flu.

CMS extended enforcement discretion for No Surprises Act QPA calculations through November 1.

 At a House Energy & Commerce Committee health panel hearing on Medicaid access, CMS Medicaid Chief Daniel Tsai expressed openness to incentivizing state auditors to double down on preventing improper Medicaid payments. 

The Department of Justice announced the creation of a new taskforce that will focus on antitrust enforcement in healthcare.

On Wednesday, CMS announced the Increasing Organ Transplant Access (IOTA) Model which would increase access to kidney transplants for Americans living with end-stage renal disease (ESRD). The proposed model would be implemented by the CMS Innovation Center.

 The Joint Commission announced it will begin accrediting rural health clinics. 

Hospital system Ascension was hit with a cyberattack on Wednesday. Some of their systems are still down and it is still unclear how many patients were impacted by the breach.