The $1.7 trillion spending plan will affect the entire health care sector.
Telehealth, physician reimbursement, training more doctors, and pandemic preparedness are among the health care provisions in the federal government’s $1.7 trillion budget for 2023.
By the end of 2022, doctors and medical industry leaders were expecting various organizational actions that could affect health care. Some of this happened with the approval by Congress of the “Consolidated Appropriations Act, 2023” with 4,155 pages, signed by President Joe Biden on Dec. 29.
There were summaries and responses from medical groups including the American Telemedicine Association (ATA) and ATA Action, the American Academy of Family Physicians, and the American Hospital Association (AHA), which published a 10-page list of health care policies and practices of money.
Lawmakers have approved telehealth reforms to address the COVID-19 pandemic. Most of those 151 would expire after the end of the public health emergency of COVID-19.
Instead, the bill would expand and expand health care flexibility on Dec. 31, 2024. Among those cases:
- Expanding origin sites to include any sites where patients are located, including patients’ homes.
- Additional coverage and payment for audio-only telehealth services.
“This is a clear testament to our excellent elected officials at work, first making changes to allow health services to deliver care to patients remotely during a time of unprecedented global violence,” said ATA leader Kyle Zebley in a statement. Zebley is the ATA’s senior vice president of public policy and executive director of ATA Action.
“Now, as telehealth has proven to be a life-saving and critical option for millions of Americans, our congressional leaders on both sides of the aisle have taken the necessary steps to ensure that these services will remain available for the next two years, while we seek permanent legislation at the federal and state levels,” Zebley said. .
The federal spending plan “contains several provisions that move our nation closer to our goal of ensuring affordable, equitable and comprehensive care for all,” said AAFP President Tochi Iroku-Malize, MD, MPH, FAAFP, in a published statement. “We applaud the extension of Medicare telehealth flexibility, including audio-only telehealth, through the end of 2024. This preserves patients’ access to virtual care and provides doctors with predictability.”
Despite that good news, physician reimbursement cuts threaten the health care promises made to seniors and will reduce access to timely care for many, Iroku-Malize said.
The Medicare Physician Fee Schedule includes a 4.5% cut that will take effect this year. That will drop to 2% in 2023 and about 3% in 2024, according to the AHA.
But any reduction is unacceptable, Iroku-Malize said in an AAFP statement.
“Coupled with inflation and rising practice costs, any reduction in payment puts an undeniable strain on family medicine and other physician practices,” Iroku-Malize said. “This ultimately worsens beneficiaries’ access to timely care, hinders progress towards resource-based care and accelerates the consolidation of health care. Congress must act to ensure that Medicare physician payment policies support comprehensive and sustainable primary care, keep up with rising practice costs and stop the annual threat of Medicare cuts.
“It is imperative that lawmakers take strong action on comprehensive Medicare payment reforms so that patients can access the quality care they deserve, and physicians have the resources and flexibility they need,” Iroku-Malize said.
The AHA noted that the spending plan would delay the successor to the Pay-As-You-Go Act, known officially as PAYGO, for two years. Without that delay, Medicare would have had a $38 billion cut starting this year.
The federal budget will add incentive payments to other types of payments for an additional year, until the 2025 calendar year. However, incentive payments will be at 3.5% instead of 5%.
In a published statement, AHA President Rick Pollack praised Congress for recognizing the pressure on hospitals, health systems, and caregivers, but their financial situation is dire.
“This legislation will provide critical support and resources so we can better care for our patients and build healthier communities,” Pollack said. “Due to rising costs of supplies, equipment, drugs and personnel, challenging staff shortages, and the ‘tripledemic’ of COVID-19, influenza, and RSV, the hospital field is stretched and on edge.”
The federal budget includes 200 positions for medical studies funded by Medicare beginning in 2026. At least half of those will be dedicated to mental and psychiatric residences, and 10% will be distributed to hospitals in rural areas, those that work above their caps, in the provinces. and new medical schools, as well as those that fill shortages of health professionals.
Medical device manufacturers will have new cybersecurity requirements, some of which will go into effect in 90 days. The US Food and Drug Administration should provide more resources for device cybersecurity and the Government Accountability Office will have a year to identify how federal agencies can improve device cybersecurity.
Lots to learn
“The law takes several steps aimed at improving the government’s ability to prepare for emergencies,” with $120.7 billion for the US Department of Health and Human Services and its agencies, according to the AHA.
The Senate will be required to ratify the Centers for Disease Control and Prevention (CDC) starting in 2025, when the CDC creates a new agency-wide plan for communications, partnerships, and coordination with other emergency agencies.
In his statement on the budget, Biden noted the creation of a new Advanced Research Projects Agency for Health (ARPA-H) to “advance cutting-edge research on cancer and other diseases.”