Even as members of Congress prepare for the Christmas recess, political issues continue to be debated and lawmakers’ hours are running out; Among the issues being resolved as of late are questions about the extent of telehealth flexibilities, reimbursement levels for alternative payment models, and managed care prior authorization regulations.
As has become a routine element of Congressional operations, the United States federal government is funded through Continuing Resolution (CR) appropriations rather than longer-term budgets. On Thursday afternoon, December 17, leaders of associations representing medical groups issued statements regarding what was happening in the Czech Republic at the time. And it’s important to note that last-second changes to the draft CR drawn up in the House of Representatives on Thursday afternoon are still possible.
“The health provisions of the proposed CR represent a mixed bag for medical groups,” said Anders Gilberg., senior vice president, government affairs, in the Medical Group Management Association (MGMA) based in Englewood, Coloradoon Thursday night. “On one hand, MGMA is pleased that Congress heeded our call to extend telehealth flexibilities through the end of 2026, increase APM incentive payments to 3.53%, and expand the Medicare 1.0 work GPCI floor . These are big victories for medical groups. On the other hand, we are deeply disappointed that Congress has failed to fully remedy the impending cut in Medicare payments to physician visits in 2025. Any cut, no matter how small, is unacceptable. Finally, not including legislation to reform prior clearance, which has the support of a bipartisan majority in the House and Senate, nearly 500 supporting interest organizations, a CBO score of zero, and little to no opposition, represents a huge weekend in Congress. “A year of failure and another victory for big insurers to the detriment of American patients.”
Meanwhile, Aisha Pittman, senior vice president of government affairs at NAACOS, the National Association of ACOs based in Washington, DCwhich represents the interests of provider organizations involved in accountable care organizations, said Thursday night that “The National Association of ACOs (NAACOS) commends Congress for including an extension of the Advanced Alternative Payment Model (APM) incentive to 3.53 percent in the Additional Continuation. Disaster Relief and Appropriations Supplemental Appropriations Act of 2025. This critical incentive allows physicians to drive innovation in healthcare while improving patient outcomes and reducing costs. “We also appreciate the reduction of physician payment cuts by 2.5 percent, a step to ensure that physicians are adequately compensated and motivated to embrace value-based care.”
Additionally, Pittman said, “Value-based care is transforming health care delivery by prioritizing prevention, improving care coordination, and expanding access to services beyond those traditionally covered by Medicare, all of which contribute to maintaining to healthy patients and more efficient systems. It is critical to create pathways for all physicians to participate in APM that free providers from the limitations of the fee-for-service model and focus on value over volume. “NAACOS looks forward to working with Congress to design a long-term, sustainable approach to physician payment reform that supports the transition to high-value, patient-centered care,” he added.
This is a developing story; We will post updates as new developments warrant.
