HealthCare Roundtable e-News – April 15, 2024



Register Today – Medicare Prescription Payment Plan (MP3) Program

The Impact on Public Sector Health Plans

Webinar | Wednesday, April 24th at 2:00 PM (EDT)

Join us for an insightful webinar hosted by the Public Sector HealthCare Roundtable, where we’ll delve into the intricacies of the upcoming Medicare Prescription Payment Plan (MP3) Program. Set to roll out in 2025 under the Inflation Reduction Act, this program promises significant changes in healthcare accessibility and affordability. We’ll explore the fundamental aspects of MP3, including its impact on public sector purchasers with the introduction of the $2000 maximum cap on out-of-pocket costs for prescription drugs.

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Top News

House E & C Health Subcommittee Holds Hearing on Legislative Proposals to Support Patient Access to Telehealth Services

The U.S. House of Representatives Energy & Commerce Health Subcommittee held a hearing to discuss supporting and improving access to telehealth. Congress extended telehealth flexibilities for Medicare that expire in December, and Committee members focused on the benefits and concerns related to extending telehealth expansions. In his opening remarks, subcommittee Chair Brett Guthrie (R-KY) discussed long-term solutions to ensure individuals maintain access to telemedicine services and bills such as H.R.7623, the Telehealth Modernization Act, and H.R. 7858, the Telehealth Enhancement for Mental Health Act. The Subcommittee is considering 15 bills to expand telehealth access. Committee members emphasized how any telehealth expansions must focus on patient choice. Members also spoke about the benefits of telehealth for rural communities. Hearing witnesses recommended that Congress prioritize telehealth policies that increase access, promote equity, provide consumer protections, and drive high-quality care.


Impact of Supply Chain Issues on Drug Shortages in the United States

recent study published in JAMA Network Open investigates the relationship between supply chain issues and drug shortages in the United States. Drug shortages have become increasingly prevalent, leading to various adverse outcomes including missed doses, medication errors, increased spending, and even death. While companies are required to report supply chain issues to the U.S. Food and Drug Administration (FDA) since 2012, it remains unclear how often these issues translate into actual shortages. Using U.S. prescription drug purchase data from 2017 to 2021, the study conducted a population-based analysis. Drugs with supply chain issue reports were identified and matched with drugs without reports. The odds of shortages for each group were then analyzed. The findings revealed that approximately 14% of supply chain issue reports were associated with shortages within six months, with 6% resulting in severe shortages. Shortages increased during the early stages of the COVID-19 pandemic but returned to pre-pandemic levels after May 2020. Furthermore, the study observed that brand-name drugs were more likely to experience shortages compared to generic drugs, while parenteral drugs were less likely to be affected than oral drugs. These findings underscore the need for ongoing policy efforts to mitigate shortages and ensure the resilience of pharmaceutical supply chains to future shocks.


CMS Releases FY25 Hospital IPPS and LTCH PPS Proposed Rule

CMS released the proposed rule (fact sheetfull rule) for the fiscal year 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) And Long-Term Care Hospital Prospective Payment System (LTCH PPS). The rule aims to update payment rates and policies for inpatient hospitals and long-term care hospitals for FY 2025.  Some of the key highlights include a proposed increase in operating payment rates for general acute care hospitals under IPPS, projected at 2.6%, LTCH standard payment rate expected to increase by 2.8% for FY 2025, a request for information on the use of Medicare IPPS payment rates for maternity care by other payers, and updating labor market areas for the wage index based on recent census data, extending the low-wage hospital policy for at least three more years, and distributing additional Medicare-funded residency positions with a focus on psychiatry subspecialties and underserved areas.

Administrative Action

The Centers for Disease Control and Prevention (CDC) launched its updated Public Health Data Strategy for 2024-2025 and released a 2023 Lookback Report outlining previous efforts. The Health Data Strategy, which was first launched in 2023, outlines the data, technology, policy, and administrative actions essential to address challenges in data exchange between healthcare organizations and public health authorities. One of the biggest successes from the strategy for 2023-2024 was an increase in utilization of electronic case reporting (eCR). More than 36,000 healthcare facilities are now able to send eCRs – up from 25,000 in the beginning of 2023. Additional milestones met in the previous strategy include the expansion of electronic laboratory reporting, the implementation of real-time reporting, and improved data access in rural communities. The updated strategy for 2024-2025 focuses on connecting public health data systems to healthcare data systems, advancing health equity, and prioritizing investments to bridge gaps in access to advanced tools.

Congressional Action

  • Senator Tim Kaine introduced legislation to target health care workforce shortage issues. This bill, the Welcome Back to the Health Care Workforce Act, aims to eliminate common obstacles faced by internationally educated health care professionals in joining the U.S. health care workforce. Research from the Migration Policy Institute (MPI) reveals that around 270,000 unemployed or underemployed college-educated immigrants in the U.S. have health-related degrees yet are either employed in roles below their qualifications or are working outside of the health care field. This legislation would improve the ability of these individuals, who can legally work in the US, to find a job in health care at a level that is appropriate to their skill sets. The legislation would create a grant program that would, among other things, facilitate the development of local and state-level partnerships among health care organizations, community groups, higher education, and state and local governments to provide support for internationally educated health care professionals.


  • Senator Sanders (I-VT), Chair of the Senate Help, Education, Labor and Pensions (HELP) Committee, released a draft legislation proposal aimed at addressing the Long COVID crisis that is impacting some 22 million Americans. The announcement of the draft legislation follows a hearing the HELP committee held in January of 2024. In the hearing, experts emphasized a dire need to find approved treatments for the disease, to better educate healthcare workers on how to diagnose Long COVID, to further understand the risks associated with the disease, and to identify potential therapeutic options. Senator Sanders is inviting the public to comment on the draft proposal, and asks for feedback to be submitted by email to no later than the close of business on Tuesday, April 23, 2024.

Regulatory Action

The CMS Innovation Center released the proposed Transforming Episode Accountability Model (TEAM), a five-year mandatory model (beginning January 2026) that would incentivize coordination between care providers during a surgery as well as the services provided during the 30 days that follow. The model would aim to improve the quality of care for people with Medicare undergoing certain surgical procedures, reducing rehospitalization and recovery time while lowering Medicare spending and driving equitable outcomes. Hospitals required to participate would be selected based on geographic regions from across the United States. TEAM would have graduated risk through different participation tracks to accommodate different levels of risk and reward and allow participants to ease into full-risk participation. TEAM would initially focus on lower extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure. Participating acute care hospitals would receive a target price to cover all costs associated with a 30-day episode of care, and they would be required to refer patients to primary care services to support continuity of care and drive positive long-term health outcomes.

Mark your calendar:

Roundtable’s Congressional Forum

June 5-6, 2024

Phoenix Park Hotel, Washington, DC

(Registration Opens Monday, April 29th)

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November 6-8, 2024

The Mayflower Hotel, Washington, DC

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