AMGA PRESSES CONGRESS ON 2021 PRIORITIES

AMGA president and CEO calls on Congress to act on several of the organization’s priorities, including coronavirus vaccination and promotion of telemedicine.

KEY TAKEAWAYS

In 2021, Congress should provide $100 billion in pandemic relief to healthcare providers, AMGA President and CEO Jerry Penso says.

Congress should extend the moratorium on Medicare sequestration cuts through the end of 2021, Penso says.

Improvements of the Affordable Care Act this year should include expanding subsidies, extending enrollment periods, and creating caps on premium contributions, Penso says.

In a letter this week to U.S. House of Representatives Speaker Nancy Pelosi, the leader of the AMGA presents the organization’s eight priorities for 2021.

The AMGA, formerly known as the American Medical Group Association, represents more than 440 multispecialty medical groups, hospitals, and health systems nationwide. About 175,000 physicians work at AMGA member organizations.

AMGA members have been pivotal players in the country’s response to the coronavirus pandemic, wrote AMGA President and CEO Jerry Penso, MD, MBA. “Our medical groups and integrated systems have been on the frontlines of this public health emergency from the beginning and have navigated the new normal to continue providing high-quality, cost-effective, and patient-centered medical care.”

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In his letter to Pelosi, Penso highlighted eight AMGA priorities for 2021:

1. COVID-19 VACCINATION

Multispecialty medical group practices are on the frontline of the pandemic and should be involved in coronavirus vaccination efforts, Penso wrote. Practices bring several strengths to the task, he wrote.

• Practices have existing relationships with patients, which can facilitate vaccinations
   
• Practices have structures and processes in place to administer vaccines
   
• With the two vaccines approved so far requiring two doses, practices are well-suited to use existing relationships with patients to schedule, manage, and document the process of administering two shots

AMGA members should play an important role in distributing coronavirus vaccines, Penso wrote.

“Our members have the storage and staffing requirements necessary for the vaccine, but to ensure operational success, medical groups should be notified three to four weeks in advance of the number of doses they will receive. With a dedicated supply of vaccine and support, including the necessary financial support for staff, tents, and the other logistical needs to manage vaccine operations, medical groups are well positioned to quickly help vaccinate as many patients as possible.”

2. FUNDING HEALTHCARE PROVIDER RELIEF DURING THE PANDEMIC

Penso acknowledged the financial support Congress has already provided to healthcare providers through the Public Health and Social Services Emergency Fund (Provider Relief Fund) and called for more funding.

“AMGA recommends at least an additional $100 billion in new appropriations to the Provider Relief Fund during this upcoming legislative session. The increase in the number of cases, the need to cancel elective procedures, influenza season, and the current winter months create a confluence of conditions that will strain healthcare systems’ ability to respond to this national crisis,” he wrote.

In addition, Penso called for legislation that would make Provider Relief Fund money tax-free for for-profit healthcare provider organizations. “All providers, regardless of tax status, should receive the maximum amount of support from the Provider Relief Fund since it is intended to ensure the viability of our healthcare system.”

3. BOLSTERING TELEHEALTH

Telemedicine growth has been one of the positive developments of the pandemic, and Congress should promote telehealth, Penso wrote. “Not only does telehealth increase access to care, it also leads to improved spending efficiency in the healthcare system.”

Congress and the Centers for Medicare and Medicaid Services should take several actions to bolster telemedicine during and after the pandemic, he wrote.

• Congress should make the temporary waiver of Medicare’s telehealth originating site and geographic limitations permanent
   
• Payment parity between telehealth visits (including audio-only services) and in-person visits should be ensured
   
• Congress should approve the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, which provides state reciprocity in healthcare professional licensing to allow them to practice across state lines during the pandemic

4. CARE FOR CHRONIC ILLNESS

Penso called for reforming the chronic care management (CCM) code in the Medicare Physician Fee Schedule, which reimburses clinicians for non-face-to-face care management.

“Medicare beneficiaries are subject to a 20% coinsurance requirement to receive the service. Consequently, only 684,000 patients out of 35 million eligible Medicare beneficiaries with two or more chronic conditions benefitted from CCM services over the first two years of the payment policy. Removing the coinsurance payment would facilitate more comprehensive management of chronic care conditions and improve the health of Medicare patients,” he wrote.

5. MEDICARE SEQUESTRATION CUTS

Penso called on Congress to continue to spare healthcare providers Medicare sequester cuts. “Congress temporarily halted the Medicare sequester cuts through March 31, 2021. Given that COVID-19 relief and recovery efforts will go on throughout this year, Congress should approve the Medicare Sequestration COVID Moratorium Act, which would continue to halt Medicare sequester cuts until the end of the public health emergency,” he wrote.

6. CLOSING COVERAGE GAPS IN THE AFFORDABLE CARE ACT

The Affordable Care Act should be improved to provide affordable healthcare coverage to more Americans, Penso wrote. “The COVID-19 pandemic exposed certain gaps in health insurance coverage that must be addressed in order to ensure that Americans have increased affordability and coverage. Congress must take additional actions to strengthen the Affordable Care Act by expanding subsidies, extending enrollment periods, and creating caps on premium contributions.”

7. INCREASING PROVIDER ACCESS TO DATA

Congress should pass legislation that would give healthcare providers access to commercial payers’ administrative claims data, Penso wrote.

“Having access to claims data plays a critical role in patient care coordination. … Not only does access to commercial claims data help providers deliver better care, but it additionally empowers the patient. Patient access to health data will only lead to better conversations with their providers and subsequently to better health outcomes. Access to data also ensures more accountability between the provider and the payer regarding a patient’s care.”

8. ADVANCING HEALTH EQUITY

To promote health equity, Congress should act to reduce barriers to accessing medical care and social services, Penso wrote.

“It is important that Congress create legislative frameworks that address the underlying causes of inequality in the healthcare system. To that end, we support the passage of the Social Determinants Accelerator Act introduced last Congress. The legislation provides grants to assist communities with evidence-based approaches to coordinate health and social services, a key element to increasing health equity in underserved communities.”