The leaders of the Alexandria, Va.-based American Medical Group Association (AMGA) on Wednesday, Feb. 3 sent a letter to Nancy Pelosi (D-Calif.), Speaker of the House of Representatives, outlining their federal legislative and regulatory priorities, at a time when the Congress and the new Biden administration are setting in place their healthcare federal policy priorities. The letter was posted to AMGA’s website. AMGA’s leaders note that the 175,000 physicians practicing in the association’s multispecialty medical groups care for one out of three patients in the U.S. healthcare delivery system.
As noted in a press release posted to the association’s website, “AMGA today called on Congress to support the ongoing battle against COVID-19 by providing additional emergency funding for multispecialty group practices and integrated systems of care and ensuring these providers are part of the national vaccination effort. Congress created the Provider Relief Fund in response to the critical financial situation facing providers. By providing additional support to the fund, Congress can help frontline providers continue their fight against COVID-19. This support also will position AMGA members to effectively serve their communities as part of the vaccine distribution process.”
“While COVID-19 has been relentless, AMGA’s members have responded in kind and are working around the clock to deliver vital healthcare services,” Jerry Penso, M.D., AMGA’s president and CEO, said in a statement contained in the press release. “With more federal support, Congress can help providers continue to care for their communities, both by treating patients and by administering vaccines.”
As the press release noted, “In a letter to congressional leaders outlining key priorities, AMGA emphasized that healthcare providers need continued federal support because of the pandemic. AMGA also detailed several improvements in healthcare policy that apply the lessons learned from this public health emergency about how care can be provided after the pandemic. For example, AMGA members modified their care delivery models to utilize telehealth technology. Reverting to pre-COVID-19 telehealth regulations would not benefit patients or providers. In addition, AMGA recommended necessary reform to Medicare’s Chronic Care Management policies to support members’ ability to coordinate care for patients with chronic disease.”
“AMGA members continue to be committed to delivering the best care to their communities,” Penso stated. “The policy recommendations that AMGA is endorsing today reflect the reforms our members need so they can continue the fight against COVID and an update to federal policies that simply will not make sense in a post-COVID world.”
In the letter, Dr. Penso stated that “AMGA would like to share our thoughts on the most important issues for medical groups and health systems, including:
• Supporting Vaccine Administration
• Funding and Reforming the Provider Relief Fund
• Promoting Telehealth
• Ensuring Access to Care for the Chronically Ill
• Halting Medicare Sequestration Cuts
• Eliminating Coverage Gaps
• Ensuring Provider Access to Data
• Promoting Health Equity”
With regard to that list of priorities, Dr. Penso said that “As our providers are on the front line of the pandemic, the vaccination distribution strategy should enlist multispecialty medical group practices. Our members have relationships in communities throughout the country with patients in need of vaccination. With proven structures and processes in place, our members are situated to achieve the best possible outcomes. Every dose provided in one of our members’ offices means one fewer person in line at a community vaccination center. Given that currently approved vaccines require a second dose, our established relationships with our patients will facilitate the scheduling, care management, and documentation needed to ensure patients adhere to the vaccine protocols,” he wrote. “Relying on group practices to schedule appointments will relieve some of the responsibility for tracking patients from county health departments or other community vaccination efforts. Additionally, rather than requiring patients to navigate an unfamiliar state or county website, or travel to a new location, patients can contact their trusted clinicians to schedule an appointment at the appropriate time and in their usual care setting.”
With regard to financial issues, Penso wrote that “AMGA appreciates the significant support that Congress has provided to help providers’ response to COVID-19. In total, policymakers have appropriated $178 billion to the Public Health and Social Services Emergency Fund (Provider Relief Fund). 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. In addition to new appropriations for the Provider Relief Fund, Congress should approve legislation similar to the Eliminating the Provider Relief Fund Tax Penalties Act introduced last Congress, which would ensure that any funding received by for-profit medical provider entities under the Provider Relief Fund would not be taxable. 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. Treating Provider Relief Fund grants as taxable income is counterproductive to the purpose of these funds.”
Regarding telehealth, Penso noted that, “In response to COVID-19, AMGA members revised their care delivery models based on the need to keep patients safe at home. Telehealth became a vital tool in how our members care for their patients.” Because patients have become accustomed to telehealth-based care delivery, he wrote, “Congress should now recognize the important role that telehealth has in a modern healthcare system and permanently lift the geographic and originating site restrictions that normally limit the availability of telehealth,” but which will go back into effect once the public health emergency is over, unless Congress acts.
Penso also urged Speaker Pelosi and other members of Congress to support access to chronic care management, through changing Medicare regulations, noting that, “Under current policy, Medicare beneficiaries are subject to a 20-percent 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.” Importantly, he noted, Removing the coinsurance payment would facilitate more comprehensive management of chronic care conditions and improve the health of Medicare patients. Providers and care managers have discovered several positive outcomes for CCM beneficiaries, including improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department visits”; and he asked that Congress act to remove that copay.
Penso also urged congressional leaders to halt the scheduled so-called Medicare sequester cuts, writing, “Due to obvious financial strains on the provider community as a result of the pandemic, 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.” In that regard, AMGA was one of 43 national organizations that sent a letter on Feb. 3 to the top four congressional leaders—Speaker Pelosi, Senate Majority Leader Chuck Schumer (D.-N.Y.), House Minority Leader Kevin McCarthy (D.-Calif.), and Senate Minority Leader Mitch McConnell (R.-Ky.).
Penso addressed three additional areas of concern for AMGA: eliminating health insurance coverage gaps; helping providers to access claims data; and addressing the social determinants of health. He noted that while “The Affordable Care Act created an extensive expansion of health insurance access for Americans,” the fact is that “[T]he 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,” he urged.
Per data-sharing, Penso noted that, “Last Congress, the Senate Health, Education, Labor and Pensions (HELP) Committee included in the Lower Health Care Costs Act a provision that would allow providers to access commercial payers’ administrative claims data. Having access to claims data plays a critical role in patient care coordination.” He urged that Congress provide medical groups with access to commercial claims data, to help providers enhance care quality and also to empower patients.”
And with regard to equity, he wrote that, “In order to create true equity, we need to reduce the barriers to accessing care. 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.”
