First, I hope that all of you had a great holiday and I wish you all a happy, healthy and prosperous new year. It continues to be my honor to communicate with you each week as I work to keep you informed on what’s going on with your healthcare and occasionally, give you some tips and tricks on keeping yourself healthy.
While it is usually the case that nothing gets done in Washington toward the end of the year, especially during a midterm year, that wasn’t the case this year, especially in the healthcare arena. The 1.7 trillion-dollar spending bill was passed by Congress and signed by President Biden on December 29, 2022. While the 4,155-page bill funded our country for the current fiscal year, the real interesting parts of the bill, at least from my focus, were the parts that impacted our healthcare.
Most of the healthcare provisions of the funding bill dealt with the unwinding of the special regulations that were enacted in reaction to the COVID-19 pandemic. These special regulations were part of the Coronavirus Aid, Relief, And Economic Security (CARES) act and the American Rescue Plan, which were instituted to help people receive care as they weathered the pandemic. These two bills also allowed providers the ability to bill for these new care options. While the return to normal patterns of care was expected, there were some aspects of the funding bill that sought to leverage the knowledge and experience we gained during the pandemic to expand our use of remote care, especially telehealth.
Unfortunately, the change with the biggest impact had nothing to do with the pandemic but everything to do with cuts to payments to Medicare providers, especially doctors. Congress was faced with an impending 4% cut to physician payments this year and ended up reducing those cuts to 2%. This is a 2% reduction in the face of 8% inflation. This is on top of no payment increases over the last 20 years, which equates to a 22% reduction when physician cost increases over those years are factored in. Does this encourage more doctors to accept Medicare patients? Does this encourage your doctor to spend more time with you? I think not! It is a travesty that Congress and this administration continues to allow these draconian cuts at this crucial time. This is an issue that we need to focus on and get fixed.
To ensure that lower income citizens didn’t bear the brunt of the pandemic the emergency bills allowed the states to relax the acceptance qualifications for Medicaid in exchange for federal funds to offset the increased costs. The Medicaid rolls ballooned to over 90 million low-income adults and children and one report estimated that over 18 million would lose their coverage when the states returned to the old criteria. The funding bill gave the states time to transition and hopefully to help people find other coverage.
Another big change in the COVID-19 bills dealt with hospital-at-home and rural health. During the pandemic hospitals were allowed to handle emergency and inpatient cases outside of the hospital facilities. If there was a silver lining to the pandemic it was the experience gained from using remote methods for treating patients. The ability to have Medicare pay for these new treatment options was extended. Some providers are leery of implementing these new options because there is no guarantee that Medicare will continue the payments past the extension period, despite their being data that shows the efficacy of the new methods in certain cases. On top of that hospitals were facing an almost 4% pay cut in January and Congress delayed this cut as well. However, hospitals are facing serious financial instability because patients are not coming back to hospitals for regular treatments and surgeries, and providers are facing tremendous unfunded costs as flu, COVID-19 and RSV cases have surged.
Telehealth was another place where the pandemic greatly accelerated our acceptance of remote healthcare. We’ve all heard that necessity is the mother of invention and the necessity of quarantine or isolation due to COVID-19 certainly accelerated the training and identification of best practices in the use of telehealth. The waivers enacted because of COVID-19 extended the ability to provide telehealth services, allowed more types of providers to use telehealth, and continued the practice of not requiring an in-person meeting for mental health providers. With the advancement in visual, audio and data transfer devices the accuracy of remote diagnosis and treatment has increased tremendously and has increased the viability of telehealth. The funding bill extended those waivers to the end of 2024.
I think it is extremely important that we embrace these new efficient methods for remote care. Older Americans living in rural areas and people who can work at home are migrating away from readily available healthcare providers. There are medical devices and connectivity that make remote diagnosis and treatment plausible, I have seen the possibilities in the last few days at the Consumer Electronic Show in Las Vegas (tune in next week for my blog detailing what I saw at the show). We need to encourage Washington to remove the barriers that will inhibit the acceptance and utilization of these new treatment options.
There are other things in this huge bill that could impact our healthcare and I can almost guarantee there will be some unintended consequences. It has proven to be difficult to unwind some of the knee jerk responses that were initiated by the pandemic, but we need to sort through the data from the last three years and glean out the expertise and knowledge that was gained from this unique global experience and use it to not only prepare for the next pandemic but to also improve and lower the cost of our own healthcare, and remove the barriers to efficient, affordable care.
One more thing. I’ve always worked to improve older Americans’ access to healthcare, especially for those living in rural areas. Some of the innovations that will improve remote care require broadband internet access, which very often is not yet available in some rural areas. These are the very patients who would benefit the most from not having to drive long distances and are often the ones that would be the happiest to age in place. Ensuring broadband internet access for seniors, especially those in rural areas should be a priority for those in Washington.
p.s. Don’t miss next week’s blog to find out about the exciting innovations that will make aging in place easier.