Weekly Roundup (September 11-15, 2023)
Physician payment, coding, coverage, and quality reporting news highlights.
I wish to speak a bit outside of my lane of Medicare regulatory policy this week. As someone whose professional career in Washington DC began many (many) years ago working on domestic and global HIV/AIDS policy, I have been closely and anxiously monitoring the PEPFAR funding debates. For those not familiar with PEPFAR, it is the largest commitment by any nation to address a single disease – HIV/AIDS. As of September 2022, it is credited with saving 25 million lives, providing treatment to 20.1 million individuals, and helping improve the health infrastructure of many nations. It is regarded as changing the course of the HIV/AIDS pandemic. I was pleased to see former President Bush weigh in on the importance of the program this week, but an opinion piece by Arjun Sharma, MD, in STAT News, stuck with me and sent me back to those early days of HIV/AIDS. It reminds us of the real lives behind the budget numbers on a spreadsheet to which we can get numb. As Congress debates a government shutdown and politicizes evidence-based health programs, PEPFAR provides a stark example of what is at stake.
CODING
2024 CPT Codes Released. The American Medical Association released the 2024 CPT update on September 8. For the first time, Spanish-language consumer-friendly descriptors will be included. Other key updates include the consolidation of COVID-19 codes, new codes to report product-specific RSV immunizations, revisions to clarify the reporting of certain evaluation and management (E/M) codes, and the addition of a definition to determine the substantive portion of a split/shared E/M visit.
OTHER NEWS, IN BRIEF
Government Accountability Office (GAO) Considers Impact of Political Interference on Scientific Integrity at Health and Human Services (HHS) Agencies. According to the National Academies of Sciences, Engineering, and Medicine, the report notes that political involvement or inappropriate levels of influence from outside entities can compromise an agency’s professional judgment. In a follow-up to a report published in April 2022, in the wake of the COVID-19 pandemic, the GAO identified safeguards in three areas that could help select HHS agencies to protect against political experience. These safeguards include implementing transparent policies and processes with clear documentation and decision-making protocols; training of agency staff, including political appointees and career staff, on scientific integrity policies; and strengthening the institutional structure by using advisory committees or limiting political appointees. The agency concluded that no agency is fully protected from political interference and that there is an appropriate role for political appointees and elected officials to play in agency business.
Administration Announces $240 Million for Cancer Prevention, Detection and Treatment as part of the Cancer Moonshot Initiative. The Cancer Moonshot Initiative aims to cut cancer death by half by 2047. This funding, announced as part of the Biden Administration’s Cancer Moonshot Initiative, will be distributed through the Advanced Research Project Agency for Health (ARPA-H). ARPA-H will be seeking proposals on creating a biomedical data fabric toolbox. The toolbox intends to advance the next-generation software tools to synthesize and spread cancer-related health research data.
Other initiatives relate to increasing the accessibility of cancer data for researchers, increasing participation in clinical trials for underserved communities, identifying facilities for exceptional performance in cancer screening, improving interactions with veterans, and reducing exposures to environmental carcinogens.
In addition to the government initiatives, commitments from several private organizations were also announced. These initiatives included a new oncology professional navigator curriculum and certification program from the American Cancer Society and a national initiative to increase skin cancer awareness and early detection among firefighters from the American Academy of Dermatology, to name just two.
CMS Launches Medicare Enrollment Dashboard. Updated monthly, the dashboard provides infographics of enrollment data. For May 2023, the most current data available, 51% (33.9m) of Medicare beneficiaries with hospital/medical coverage were enrolled in traditional Medicare.
Source: https://data.cms.gov/tools/medicare-enrollment-dashboard
ARTICLES THAT GRABBED OUR ATTENTION
This week, these articles grabbed our attention; we thought they would also interest you.
The Revolving Door in Health Care Regulation (Health Affairs, September 2023). The authors examined Department of Health and Human Services appointees between 2004 and 2020 and found that 15 percent had been employed in private industry immediately before their appointment; at the end of their tenure, 32 percent exited the industry. CMS had a 53% exit rate to industry. The authors concluded that the revolving door to industry was neither surprising nor troubling. However, the authors did conclude that the “sheer scale… is troubling and merits further scrutiny.”
Improving Food and Drug Administration–Centers for Medicare and Medicaid Services Coordination for Drugs Granted Accelerated Approval (Millbank Quarterly, August 31, 2023). The authors recommend several administrative and legislative approaches for improving FDA–CMS coordination around accelerated-approval drugs.
UPCOMING EVENTS
Events scheduled for next week (September 18-22) are below. For a complete list of upcoming health policy events and deadlines, please visit our new Health Policy Calendar.
Sept. 18-19
Physician-Focused Payment Model Technical Advisory Committee (PTAC) Public Meeting. PTAC’s September 2023 public meeting will focus on encouraging rural participation in population-based total cost of care (PB-TCOC) models.
Sept. 19
House Energy and Commerce Committee on Health Hearing: Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology. This hearing will be held on September 19 at 10 a.m. ET to discuss legislative proposals to improve seniors’ access to innovative drugs, medical devices, and technology.
Sept. 20
House Energy and Commerce Committee and Subcommittee on Oversight and Investigations Hearing: At What Cost: Oversight of How the IRA's Price Setting Scheme Means Fewer Cures for Patients. This hearing will be held on September 20 at 2 P.M. ET To hear from experts and stakeholders about how the law has already affected new treatments and cures for patients and what we might expect in the coming months.
Sept. 21-23
CPT Editorial Panel Meeting in New Orleans, LA. This is the final CPT meeting for the 2025 CPT and Medicare Physician Fee Schedule cycle.
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For more information and questions, please contact:
Sheila Madhani, MA, MPH
Madhani Healthcare Consulting, LLC
Email: smadhani@madhani-health.com
www.madhani-health.com
Tel: (202) 679-2977