2021 CMA Federal Wrap-Up

In the NSA’s statutory language, Congress established a balanced process to fairly resolve payment disputes between physicians and insurers for certain unanticipated out-of-network medical bills, using several different criteria. However, the implementing regulations are blatantly inconsistent with the clear language of the statute and Congressional intent. They effectively upend the law, giving insurers an unfair advantage by relying almost exclusively on the insurers’ self-determined median in-network billing rate, instead of considering the multitude of factors called for under the law.

Nearly 200 Members of Congress and the Chairman of the powerful Ways and Means Committee stood with physicians, objecting to the regulations in multiple bipartisan letters.

CMA also submitted extensive comments to the regulators warning that the NSA regulations would produce the same unintended consequences that physicians and patients have experienced under California’s Assembly Bill 72. CMA provided detailed evidence from California that demonstrated how insurers cancelled long-standing contracts or imposed significant rate reductions that forced physicians out-of-network and reduced patient access to in-network physicians, particularly regarding on-call panels of physician specialists who treat patients in emergencies.

Several lawsuits have been filed against the federal government over its misguided implementation of the NSA. The suits argue that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians and other providers will routinely be undercompensated by commercial insurers, and that patients will have fewer choices for access to in-network services. Through the Physicians Advocacy Institute, CMA, along with other state and national specialty societies, filed amicus briefs in support of a lawsuit brought by the Texas Medical Association and the AMAAmerican Hospital Association lawsuit. The American College of Emergency Physicians, American Society of Anesthesiologists and American College of Radiology also filed a joint legal action.

Public Service Loan Forgiveness

In 2021, CMA continued to aggressively fight for a legislative or regulatory change to allow California and Texas physicians to participate in the Public Service Loan Forgiveness (PSLF) program like their colleagues in the other 48 states.

Congress established the PSLF program in 2007 to improve access to care by encouraging physicians to pursue careers working in nonprofit settings. When implementing regulations were issued, they were severely narrowed to require physicians to be “hired and paid by” hospitals in order to receive loan forgiveness. Because California and Texas law prohibit hospital employment of physicians, most physicians in California and Texas are precluded from participating in the program, while their counterparts in all other 48 states receive loan forgiveness.

With an average $250,000 in student loan debt, the narrow regulation places California and Texas at a severe disadvantage in recruiting new physicians, thereby harming patient access to care in our underserved communities.

On behalf of CMA, California Congressman Josh Harder (D-Stanislaus) introduced HR 1133, the “Stopping Doctor Shortages Act,” and has led an intense advocacy effort in the House to fix this problem with the

support of his co-authors, Congressmen Jay Obernolte (R-San Bernardino), Joaquin Castro (D-TX) and Van Taylor (R-TX). Identical legislation was introduced in the Senate (S 311) by Senators Dianne Feinstein (D-CA), John Cornyn (R-TX) and Alex Padilla (D-CA).

Throughout 2021, CMA urged Congress to pass a legislative fix but the high cost has made it extremely difficult.

Also in 2021, the U.S. Department of Education reopened its regulations to make changes to the Higher Education Act, which includes the PSLF. CMA testified before the education department and organized a joint bipartisan letter from the majority of the California and Texas Congressional delegations. Speaker Pelosi, Rep. Harder and Senator Feinstein have also met with the Secretary of Education on CMA’s behalf.

This is a top priority for CMA; we will continue to urge regulators and Congress to resolve the problem as soon as possible.

Access to Affordable Health Care

CMA has urged Congress to address two of our nation’s highest health care priorities in President Biden’s Build Back Better social programs infrastructure legislation – permanent access to more affordable health insurance through the ACA and lowering prescription drug costs.

Although the 2021 American Rescue Plan Act (ARPA) expanded eligibility for ACA health insurance tax credits and assistance, these provisions were only authorized for two years. CMA is urging Congress to ensure the long-term affordability and effectiveness of the ACA by making the provisions of the ARPA permanent.

The Medicare drug pricing provision in the Build Back Better plan would allow Medicare to negotiate drug prices on many of the highest-priced drugs directly with pharmaceutical companies – including all insulin drugs. The legislation is estimated to save Medicare and privately insured patients 40-60% on drug costs.

Pathways to Practice

President Biden’s Build Back Better legislation would also authorize 4,000 new graduate medical education (GME) residency positions. The nation is currently facing a 15,000 residency position shortage. This CMA-supported provision would add residency slots to allow more medical students to match with a residency program and increase the overall supply of physicians.

The legislation also includes the new CMA-supported “Pathways to Practice” program – an innovative program that will allow more marginalized and minority students to go to medical school and choose a career in medicine. It provides tuition assistance, living stipends and expands the number of GME positions. It requires such students to serve in underserved areas for six years.

This program is a significant step forward in helping our nation address racial injustice and advance health equity. It will lead to real improvements in building a more equitable health care system for providers and patients.

Also this year, CMA supported multiple bills that addressed racial injustice and health care disparities and promoted adoption of AMA’s plan to “Embed Racial Justice and Advance Health Equity.”

Conclusion

CMA was honored to fight for physicians in the virtual halls of Congress this year and we will keep fighting so that you can focus on your patients and not be hindered by administrative burdens, declining reimbursements or a devastating virus.

While Congress did not finalize all of CMA’s priorities, important groundwork was laid for Congress to enact a more stable Medicare payment system that keeps pace with increasing practice costs, Medicare Advantage prior authorization reforms, public service student loan forgiveness for California physicians, the health care provisions in the Build Back Better plan, permanent telehealth waivers and bills that address physician workforce shortages. CMA will continue to stand with you and advocate on your behalf.

RESTORING JOY TO THE PRACTICE OF MEDICINE TOGETHER

Through the Bay Area Clinician Wellness Collaborative

REGISTER AT

https://www.pathlms.com/medical-society/courses/40312

Physicians passionate about wellness from medical groups, health clinics, medical sta s, residency programs, and other physician organizations throughout the Bay Area are invited to this free online conference over two half-days on April 21 and 28.

KEYNOTE SPEAKERS

JOHN CHUCK, MD Former TPMG Regional Chair for Physician Health and Wellness Leaders

MARIE BROWN, MD AMA Director of Practice Redesign PAUL DeCHANT, MD Healthcare Consultant

THURSDAY, APRIL 21

PRACTICE WISELY AND SAVE TWO HOURS PER DAY (9:00 am)

Marie Brown, MD

STRATEGIES AND BEST PRACTICES IN CLINICIAN WELLNESS: THE ROLES OF LEADERS, TEAMS, AND INDIVIDUALS IN PROMOTING JOY AND MEANING (10:00 am)

John Chuck, MD

PRACTICE IMPROVEMENTS IN ACTION (11:00 am)

Panel discussion with Vanessa Calderon, MD, Vituity Resiliency Director; Jill Jin, MD, AMA Senior Physician Advisor and Clinical Assistant Professor, Northwestern School of Medicine; Irene Lo, MD, Epic Care

THURSDAY, APRIL 28

PURSUING PROFESSIONAL FULFILLMENT: ADDRESSING THE DRIVERS OF BURNOUT IN THE CLINICAL WORKPLACE (9:00 am)

Paul DeChant, MD

SMOOTHING THE BUMPS ON THE ROAD TO CLINICIAN WELLNESS (10:00 am)

Panel Discussion with Linda Hawes Clever, MD, MACP, President of RENEW; Marcia Nelson, MD, Chief Medical Officer, Enloe; Larissa Thomas, MD, Director of Well-being for UCSF GME

TRANSFORMING LEADERSHIP FOR A CULTURE OF WELLNESS (11:00 am)

Panel Discussion with Anastasia Klick, MD, MPH, Salinas Valley Medical Clinic; Aman Sethi, MD, TPMG Director of Wellness Operations; Emily Shaw, MD, Sutter Medical Group of the Redwoods