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Senate committee kicks off Medicare physician payment reform talks

April 11, 2024

With government funding finally resolved in March, Congress is turning its attention to Medicare physician payment reform with an April 11 hearing at the Senate Finance Committee.

Senators and physician witnesses highlighted the flaws in the existing Medicare payment system, with Ranking Member Mike Crapo (R-Idaho) channeling the concerns of specialists and ASTRO.

"A successful legislative initiative must reckon with a range of challenges under the current paradigm, which has served to devalue and distort payments for vital services, as well as to exacerbate administrative burdens. In inflation-adjusted terms, Medicare Physician Fee Schedule payments have declined by more than 25% over the past two decades, even as clinicians continue to face skyrocketing costs for overhead, equipment, supplies and staffing needs,” said Senator Crapo. “For many specialists, recent regulatory changes have further intensified these issues, as new billing codes and valuation shifts have triggered drastic cuts under the program’s budget-neutrality rules. Based on inflexible cost containment measures, a payment bump for primary care prompts payment reductions for entirely unrelated procedures and services, from brain surgery to advanced cancer care.”

Focused on ways to enhance payment and care coordination for chronic conditions, senators and witnesses expressed frustrations with burdensome and low value quality reporting programs and challenges in transitioning to value-based payment. Medicare Advantage did not escape criticism during the hearing, as senators and witnesses also criticized excessive prior authorization, which Chairman Ron Wyden (D-Ore.) termed “outrageous.”

Congressional committees are expected to ramp up discussions about ways to reform Medicare physician payment as the year goes along, and ASTRO is working to ensure that the proposed Radiation Oncology Case Rate program is a key component of reform options.

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