AMGA Execs: Medical Groups Need Congressional Support to Survive the Pandemic and Move Foward

Nov. 19, 2020
In the wake of a letter to congressional leaders pleading for ongoing financial support to medical group practices during the pandemic, three senior AMGA executives shared their perspectives on what’s at stake right now

As Healthcare Innovation Managing Editor Rajiv Leventhal wrote in a report on Nov. 17, “In response to the surge in positive COVID-19 cases and the increase in hospitalizations, leaders at the Alexandria, Va.-based trade association AMGA have called on Congress to provide additional support for healthcare providers. With daily COVID-19 cases topping more than 181,000 in a single day, and hospitalizations reaching a record high of more than 69,000, AMGA members are preparing for an increase of patients by postponing or canceling procedures so that the staffing, personal protective equipment, and hospital space are available for patients with COVID-19, the association stated. More than 175,000 physicians practice in AMGA’s member organizations, delivering care to one in three Americans.”

AMGA’s president and CEO Jerry Penso, M.D. said in a statement included in AMGA’s Nov. 16 press release on the subject that, “Earlier this year, Congress recognized the need for an immediate response to support healthcare providers,” said AMGA President and CEO Jerry Penso, M.D. “Based on the current facts on the ground and this rapid increase in cases, additional financial support is now needed.”

The press release went on to state that “AMGA recommends that Congress replenish the Public Health and Social Services Emergency Fund (Provider Relief Fund) and instruct federal regulators to restart Medicare’s Accelerated and Advance Payments (AAP) program. These two programs offer critical financial assistant to providers that are facing increased costs due to COVID and a disruption of their usual patterns of care, the association contends.”

In the press release, the association also stated that, “In addition, Congress also should permanently lift the geographic and originating site restrictions that normally limit the availability of telehealth. On this front, there are several bills that have been introduced that call for removing geographic restrictions, expanding originating sites where patients could be eligible for telehealth, as well as broadening the scope of which Medicare providers are eligible to provide telehealth and get reimbursed for it. While the federal government has removed many telehealth restrictions during the public health emergency (PHE), it’s still unclear which ones will go back into place once the PHE ends. Patients accustomed to such care will expect it to be available after COVID-19 subsides.” And, the association said that, “Additionally, AMGA recommends that Congress address several policies that will provide stability to the Medicare program, while ensuring that providers maintain their ability to deliver high-quality care during the crisis. These include “preventing significant reimbursement cuts that are pending in the Medicare Physician Fee Schedule, reaching consensus on surprise billing legislation that protects patients and does not set reimbursement rates, and ensuring providers have a meaningful opportunity to participate in value-based models of care.”

In that regard, the association noted, referencing a letter sent to congressional leaders on Nov. 16, that, “Specifically, AMGA’s letter brings up that CMS is considering substantial spending cuts in the Medicare Physician Fee Schedule through proposed changes to Evaluation and Management (E/M) codes, and if those proposals become finalized, there will be excessively steep reductions in Medicare reimbursement for select specialties. Should CMS move forward with its proposal, some provider payments would be reduced by as much as 11 percent.”

On a broader policy level, the Nov. 16 letter stated that “Congress also has an opportunity to continue the transition to a value-based healthcare system by reforming the qualification thresholds for the advanced alternative payment model (APM) program. As currently implemented, 50 percent of providers’ revenue must be received through an Advanced APM; that threshold will increase to 75 percent in January. AMGA said they are “concerned that without revising the thresholds, the movement and support for value-based care will stall. Part of the issue is the dearth of access to commercial risk products and limited Medicare Advanced APM options. To correct this situation, Congress should reduce these thresholds to reflect actual market conditions, which would, in turn, result in increased Advanced APM participation,” the letter stated.

Later this week, AMGA policy and advocacy leaders spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the association’s requests of Congress, and the current policy moment. The three AMGA senior executives whom Hagland spoke with were Chet Speed, chief policy officer; Jamie Miller, senior director, government relations; and Darryl Drevna, senior director, regulatory affairs. Below are excerpts from that interview.

Looking both at the financial and operational issues triggered for medical groups by the COVID-19 pandemic and other policy and payment issues right now, what is your 40,000-feet-up perspective on this policy moment?

Chet Speed: The letter emerged out of multiple discussions we had with our public policy committee, which includes 24 medical groups, and discussions with about 60 CFOs at our groups. And they point to a picture which is clinically, financially, and administratively hitting them at the worst time. They had been recovering somewhat in the late spring, but infections have increased markedly, and what’s happening is that many of our members are canceling members and asking folks not to come into their offices in person; in addition, not only are staffers getting sick with COVID, but even those who aren’t getting sick are experiencing stress from dealing with this virus every day. It’s actually causing staffs to break down. There’s a lot of fear, including over shortages of PPE. There’s a sense of unrelentingness. And I think it’s important for Congress to understand that the situation is not going away. We received $175 million from the fund this spring, but the fund needs to be replenished, and PPE [personal protective equipment] remains an issue. I know that President-elect Biden has talked about the need for PPE. But this was about telling Congress that this is just a massive, massive issue for us.

Jamie Miller: Chet summed it up very well. Obviously, labor issues with the mental health of our workforce, are an issue, and obviously, childcare is an issue as well. With the continuing resolution expiring on December 11, that obviously provides an opportunity. So we want Congress in the lame duck session to do something and work together, and we’re urging them to do that. And obviously, when President-elect Biden comes into power, he’ll have an opportunity to do something.

Are we in a bit of a policy limbo right now in terms of discussions that could be taking place, because of President Trump’s refusal to allow the transition to go forward with the incoming Biden administration?

Speed: I’ll answer that honestly. We have the Biden folks saying that they’re not able to have discussions. So that probably is an issue. I assume that informal discussions are happening anyway.

Are you able to actively lobby Congress right now?

Speed: The presidential transition doesn’t affect Congress at all; they still control the spending and legislation.

Jamie Miller: It’s complex, but when you talk individually to members of Congress, they’re all talking with us and realize that it’s a problem that needs to be addressed. We’ve talked to a lot of members on both sides of the aisle, and they also want to promote telehealth beyond the public health emergency, and that’s bipartisan.

Do you think that payment parity for telehealth will continue beyond the public health emergency?

Miller: When we talk to our members and they talk about this being the new norm, and they’ve invested in infrastructure to ensure that, our position is that we want that coverage to extend beyond the emergency.

Is it CMS [the Centers for Medicare and Medicaid Services] or Congress that will extend this?

Darryl Drevna: They both [created the policy relaxations this spring]. CMS at the beginning of the pandemic, issued some emergency regulations that waived some telehealth restrictions to the extent that they could, and Congress then passed legislation to give them more authority, so CMS put out a second interim final rule to modify telehealth regs, all linked to the declaration of the public health emergency. When that declaration goes away, though I don’t think it will anytime soon, those elements will go away, so it will take congressional action.

Miller: [CMS Administrator] Seema Verma has been very bullish on telehealth, and our members have invested a lot in time, effort, and treasure in telehealth; and there’s a lot of support in Congress for that. So we need to work out what’s appropriate for telehealth versus face-to-face. So there’s a move to make the waivers permanent soon or at least to extend the waivers for a while, while developing appropriate payment waivers for it.

What does the next 24 months look like, in terms of policy around payment innovation?

Miller: From a value perspective, as you know, Congress and the administration spent over $3 trillion on COVID and will spend some more, and our members will be leading innovation, an I think the medical group model is the way towards the future of medicine, and we’re just going to continue to promote the medical group model. And going forward, there’s obviously going to be a lot of discussion about how our system progresses.

Drevna: There are two things going on here. One, AMGA and its membership will continue to go towards value-based and population health-based models, because there’s really no alternative. That said, what HHS [the Department of Health and Human Services] is going to do will depending on who’s staffing HHS, and how we come out, post-pandemic, and what our capacity is. We’re going to keep moving ahead, and I’m going to be working to make sure that HHS and Congress see us.

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