Wins were achieved for prior authorization reform, while significant efforts were made toward preventing physician payment cuts
Jan. 10, 2025 (ACP) -- The American College of Physicians made significant inroads on several key advocacy issues in 2024 at the state and national levels.
“Overall, we did well. We achieved quite a bit in terms of prior authorization reform, and Congress is listening to us with regard to physician payment issues and understands the problem,” said Shari Erickson, ACP chief advocacy officer and senior vice president of governmental affairs and public policy. “We can build on this in the coming year.”
Specifically, ACP led the charge to shape prior authorization reform, resulting in the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule, according to Erickson. This rule requires Medicare Advantage plans to make decisions within 72 hours for expedited requests.
“This was a significant win. We are pushing on Capitol Hill to codify this rule and will continue to push for this in 2025,” she said, adding that it has bipartisan support. ACP chapters in New Jersey, Ohio, New Hampshire and Kentucky also supported efforts to pass state legislation to reduce prior authorization burdens.
In addition, ACP helped drive the inclusion of new report language in Congress' appropriations bills for 2025. The language calls for a review of whether CMS has overestimated utilization of certain Medicare codes to prevent unnecessary cuts. “Without this language, the overestimated amount leads to an overall reduction in payments within the fee schedule due to budget neutrality,” Erickson explained.
In 2024, ACP recommended CMS support key reforms and oppose cuts to physician payment rates. These efforts will continue in order to secure adjustments for January 2025.
Unfortunately, a 2.8 percent payment cut in the Medicare Physician Fee Schedule went into effect on Jan. 1. Early reports indicated the end-of-year stopgap funding bill would mostly reverse the cut and reduce the amount of the PFS reimbursement reduction to 0.3 percent, but the final continuing resolution did not include this adjustment, keeping it at a 2.8 percent payment cut. “This is obviously tremendously disappointing,” Erickson said, “and so, ACP will be strongly advocating for Congress to take care of this unfinished business immediately in 2025.”
ACP also successfully advocated for extended telehealth flexibilities. Coverage for audio-only visits and a delay of in-person requirements for behavioral health services will continue through March 2025. “We hope it will be included in an appropriations bill in the new year and continued for much longer,” Erickson noted.
Also in 2024, Medicare was granted the ability to directly negotiate the prices of certain high-expenditure drugs without generics or biosimilars. The first 10 drugs were announced in August, and the next set should be announced soon, according to Erickson. “Drug companies have since sued Medicare, and ACP has been joining in amicus briefs to support Medicare's ability to negotiate drug prices,” she said.
ACP also defended against legislation that would expand pharmacist scope of practice beyond safe limits. An ACP toolkit provides resources for members to advocate on this issue at the state level.
Finally, ACP opposed legislative efforts to ban diversity, equity and inclusion programs in medical education. The College also issued policy papers and made recommendations on the use of artificial intelligence in health care, cannabis research and gender minority health disparities and worked to reduce the burden of low-value performance measures, including those on major depressive disorder and pain in adults.
More Information
An infographic, “What ACP Advocacy Achieved for You and Your Patients in 2024,” can be viewed on the ACP website.
Back to the January 10, 2025 issue of ACP Advocate