American College of Rheumatology Disappointed in Medicare Payment Cuts, Lack of Prior Authorization Relief in Year-End Package

ACR Supports Certain Provisions Included in Two-Year Budget Deal

WASHINGTON, DC – The American College of Rheumatology (ACR) today expressed disappointment that the bipartisan year-end package failed to fully delay and address the Medicare reimbursement cut to providers scheduled to go into effect on January 1 and completely excluded reforms to Medicare Advantage prior authorization policies like those included in the Improving Seniors Timely Access to Care legislation unanimously passed by the House earlier this year.

Members of Congress recently passed partial relief to the -4.5% Medicare reimbursement cuts finalized in the 2023 Physician Fee Schedule by CMS earlier this year. The cuts were reduced by 2.5% for 2023, giving providers some relief in the new year. Congress also delayed the implementation of the -4% PAYGO sequestration cut until 2024. While these provisions give specialty providers some relief amid the negative impacts of the COVID-19 pandemic and inflation, there remains serious concern about the financial stability of the healthcare system and the impact on patient access to care.

“The current system for reimbursing care to Medicare patients by physicians is unsustainable and immediate reforms are necessary, and even more pressing with these cuts, to secure a medical workforce and protect patient access to quality care,” said Douglas White, MD, PhD, President of the ACR. “The ACR will continue to advocate for near-term support and long-term solutions to this issue.”

The omnibus package also left out the Improving Seniors Timely Access to Care Act. The hugely popular bill would have streamlined and modernized the prior authorization process under Medicare Advantage by establishing an electronic prior authorization process and requiring the federal government to create a process for real-time decisions for routinely approved treatments.

The ACR was pleased to see the following provisions included in the two-year budget Congress has approved:

• $15 million for the Pediatric Subspecialty Loan Repayment Program.
• 200 additional slots for the Medicare Graduate Medical Education (GME).
• Extension of the COVID telehealth benefits for Medicare beneficiaries for 2 additional years
• Investment in Advanced Research Projects Agency for Health (ARPA-H) to innovate.
• Extension of CHIP to 2029 with guarantees of 12 months of coverage and expanded post-partum care.

“While the ACR celebrates these wins, we will also continue to fight barriers to patients’ access to high quality care and advocate for necessary improvements to both the Medicare reimbursement system and prior authorization requirements. In 2023, the ACR looks forward to working with the new 118th Congress to enact policies that will improve healthcare outcomes,” White concluded.

 

Media Contact
Monica McDonald
mmcdonald@rheumatology.org
404-365-2162

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About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.