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In today’s AMA Update, American Medical Association Director of Congressional Affairs Jason Marino joins to discuss the latest advocacy efforts on Capitol Hill for Medicare payment reform and telehealth. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Jason Marino, director, Congressional Affairs, AMA
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking with our Director of Congressional Affairs, Jason Marino in Washington, D.C., about the latest developments on Capitol Hill with Medicare payment reform and telehealth. I'm Todd Unger, AMA's chief experience officer in Chicago. Jason, it's good to have you back.
Marino: Hi, I'm happy to be back, and thanks to the audience for tuning in today.
Unger: Well, we got a lot to talk about and something that people are really interested in hearing the details of. Reforming Medicare payment, of course, is a top priority for the AMA. The newly released Medicare physician payment schedule for 2024 underscores the urgency of that work. Jason, what are some of the key takeaways from that proposal that physicians need to know?
Marino: Let me just first start by saying this proposal comes out once a year. The CMS, Center for Medicare and Medicaid Services, puts out physician fee schedule every year, usually just before Fourth of July or just after. 1,000 pages—so I don't expect the physicians listening to have read that.
But I can just tell you that some key takeaways—the Cliffs Notes version—that 1,000 pages, what you can read into that is that they said there's going to be a new 3.3% cut across the board for Medicare. That's what's in there.
Also, what's in there is an acknowledgment that for 2024, the MEI, this is the Medicare Economic Index, this is what measures practice cost inflation, should be 4.5—4.5. So the same document, 1,000 pages, it says we're going to cut you 3.36%, says but we should be giving you 4.5. That's what your practice costs are.
But you're not going to get that. You're going to get the cut—3.36. So that's a lot to take, and that's a big wake-up call—another wake-up call that we've got to reform this Medicare physician payment system. It's broken. It's not working.
Unger: Jason, you lay out that gap. And we know that physicians were already at a breaking point. And this cut is just going to compound the challenges that they're facing.
One way to fix Medicare payments is to tie it to inflation. There's a bill that's been introduced to do just that, and you've been working to rally lawmakers behind it. Where do things stand right now on that?
Marino: So this is to bill. This is the H.R. 2474. And we play on the—we play on the number of H.R. 24 because we're working on it 24/7. But it's called the Strengthening Medicare for Patients and Providers Act.
It was dropped back and introduced back in April. And it was strategically done so earlier in the year because we knew Congress was about to have a massive debt limit fight about spending. And when these big fights happen, everything shuts down. It takes all the oxygen out of the room. And so we wanted to get it dropped then, and we got a bipartisan bill.
Doctor Congressman Ruiz and Doctor Congressman Bera—excuse me—Bucshon from Indiana and others jumped on. And we have about 50 people right now, 50 members of Congress that have committed to supporting this legislation.
But now we're passed the debt limit. And that's kind of—it's calmer waters. Congress just left for a six-week, five-week congressional recess. So we're at a time a strategic time where we need to start getting those numbers up or trying to get the numbers much higher. And so I like where we are in that we're starting to get some good signers, but we have a lot more of a hill to climb.
Unger: What do you think is holding back even more lawmakers from supporting this bill? And how do you convince them beyond—the numbers that you laid out are pretty straightforward and not sustainable. What—how do you get them to realize this is necessary?
Marino: There's three things that are working against us. One is this bill, this legislation to give physicians an inflationary update. This is scored by what's called the Congressional Budget Office. They do scores on every bill.
They haven't put out official score, but they've told members of Congress, look, over a 10-year period, this is going to $100 to $300 billion, with a B, billion dollars. That's a lot of money. That's one of the biggest asks in Washington.
And the debt, the national debt, is $32 trillion. And there's a lot of members really concerned about we're spending $2 billion a day on just the interest on that debt. We don't have the money to do this. That's one thing.
The second one is if we were going to spend $100 billion, I'd rather spend it on roads and bridges. I'd rather spend it on—for the farm bill. I'd rather spend it on another priority than for physicians and Medicare.
The third one is just the noise. The members of Congress get hit in all different directions. And how do you make it a priority? And how do you break through that?
Unger: I'm curious. When you talk to them again, back to the convincing part, what's going to be the outcome of a cycle that has costs raising substantially and cuts in reimbursement combined? What will happen then on patient care?
Marino: I think that's the story that needs to be told. And there's a truism that I've been following that I've learned recently that I just want to share. And it's that logic does not persuade people. Clarity, storytelling and appealing to self-interest do. This applies to our world in advocacy.
There's no logic behind this payment system in Medicare that cuts physicians every year and has no inflationary update. Members of Congress and their staff will intellectually agree. There is no logic behind this.
But how do you get them to actually do something? How do you actually get them to act, to pass a bill? That's where I think the physicians listening to this today, that's where they really fit in. They're the crux.
And clarity—you can look at—we put a website together fixmedicarenow.org. And it has all of the graphs that crystal clear show here's all the providers in Medicare. Physicians are the one that goes down—no update and a cut. You don't get any clearer than that. And we have several documents that kind of walk you through the problems that our audience lives in those. That's one thing—clarity.
Storytelling—we need physicians back home to tell their story. What does this mean? What do these cuts mean for you, your practice, the colleagues in your practice, the suppliers in your practice, the patients who you may or may not be able to see in the future, whether your practice can exist in the future back home in the state, back home in the district, in only a way that a physician living it can do, not someone in DC that can advocate and win the intellectual argument, but a story that only you can tell.
And then third—self-interest. Most members of Congress, they go in for the right reasons. They want to make their lives back home in their district better. That's why they got into it. They want to solve problems.
This is a big problem. People like their physicians. They have their own self-interest for their own health care and for their family and loved ones and constituents health care. That's a big one.
And don't ever doubt. This issue has been around for a long time. The self-interest of—I often get this. You're back again with a new cut? You're back every year—every year. We're tired of it.
And I'm tired of it too. The physicians are tired of coming every year back to stop a cut. You want us to go away? Fix the problem. Don't ever underestimate that kind of wearing them down. But I think that's how you persuade people, and that's the advice I would share today.
Unger: Great advice. And I just want to emphasize for everybody that's listening out there, please visit the site fixmedicarenow.org. As Jason said, and we've heard from different Congress people that we've had on the AMA Update, your stories, your letters, your outreach to Capitol Hill, it really makes a difference. Please contact your members of Congress and encourage them to support H.R. 2474.
Jason, Medicare reform is not the only issue that we're advocating for on Capitol Hill. Fifth leg of the Recovery Plan for America's Physicians is about supporting telehealth. And we saw a big win on this front recently with the reintroduction of the Connect for Health Act. Tell us more about that.
Marino: Absolutely. Let me just step back and say telehealth and Medicare are something that the AMA has been working on for a long time. And 2017, only 1% of seniors were even using telehealth. Even though the technology was there, it just wasn't covered.
And we got some work done—some legislation, bipartisan legislation, earlier versions of this Connect for Health Act that you just mentioned. Earlier it didn't go anywhere. We came right back at. Next Congress, went right back at it. Got some small pieces of it into law. Went right back at it.
And then during COVID, one of the silver linings of COVID was that they were able to take some of this bill and put it into law to allow Medicare coverage for telehealth. And boy, it worked. It was a great tool. It's not a panacea, but it was a great tool and it worked.
And last time you had me on, maybe it was a year and a half ago, I was saying, we just got this extension when the public health emergency ends, the Medicare coverage for telehealth is going to go away. We got a five-month extension—151 days.
You probably thinking—151 days? You're bragging about that? Come on. That sounds like Washington speak. And I was saying but think longer picture.
Once Congress—you get something in motion in Congress, one of the laws of physics in Congress is that you extend something. You keep—it keeps extending. And that turned into a two-year extension. So we went back later after that—after our last podcast—and we got a two-year extension. So through 2024, we have—there's coverage for telehealth.
And this bill you just mentioned that we got introduced, Amy worked on that closely with the sponsors—bipartisan bill. This says this should be permanent. It shouldn't be—we don't need to live by extensions. Let's make it permanent. So when it expired in 2024—permanent coverage Medicare telehealth.
We got 61 senators to introduce it. It never happens. Health care bill, the consequence. And 60 and the front end introduce it together, bipartisan. That is a great thing to happen, and it got a companion bill in the House of Representatives. And so now, we will get more sponsors. And Congress always acts on deadlines.
So towards the end of the fall of next year, of 2024, it'll be when the extensions are expiring. And we'll have this bill ready to go. Just pass this bill. It's vetted. It's ready to go. Make it permanent.
And we'll have a lot of seniors and physicians, patients supporting it. And so it may not seem like oh, just a bill got dropped. No, there's a lot behind it—a lot of strategy behind that. So we're excited about that.
Unger: And it's that story of just the constant work of advocacy and the power of working with the folks on Capitol Hill with a unified voice. Again, Jason, thanks to you, and thanks to the advocacy team at the AMA and across the federation for the great work here.
That's it for today's update. We'll be back with another episode soon. In the meantime, you can check out all our videos and podcasts at ama-assn.org/podcasts. Thanks again for joining us today, and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
