The U.S. Congress has major influence in healthcare, from determining physician payments to making laws regulating who can own healthcare facilities.
Adam Bruggeman, MD, an orthopedic surgeon at Texas Spine Center in San Antonio, is an active advocate for physicians in Congress, regularly lobbying for payment reform, physician-owned hospital legislation changes and more.
Dr. Bruggeman told Becker's why political advocacy is so important and the key pieces of legislation he is watching this year.
Question: Why do you think it's important for spine and orthopedic surgeons to get involved politically?
Dr. Adam Bruggeman: As the saying goes, you are either at the table or you are on the table. Many physicians decide to remain out of the political process given the hyperpolarized nature of our country currently. I would argue that this isn’t about politics, but instead about advocating for our patients and our profession. You can advocate without being political. Our healthcare system is currently in significant flux and physician leaders can help guide politicians and regulatory agencies as to the best pathways forward. If we sit in silence, others, including insurers, hospital systems and large corporations, will decide the future of medicine.
Q: What legislation/advocacy efforts are you following right now?
AB: Let’s be honest, the practice of medicine by physicians is under a multi-front assault. We are on the brink of a fifth consecutive cut to physician pay next year. Prior authorization is expanding at exponential rates. Inflation has led to dramatic increases in the cost of doing business, particularly for staffing. Documentation, outcomes measurements and the general administration of practices continue to expand and outstrip resources. All of this is happening while Congress blocks physicians from owning hospitals and provides benefits to hospitals that purchase practices by allowing higher payments for the same services when provided in a hospital outpatient department. To say the deck is stacked against physician practice is an understatement. I am watching the various efforts to combat consolidation, which has been a cancer to our profession and to the health of our nation. These include:
1. Ensuring a sustainable and long-term payment methodology that ensures stability of physician practice
2. Reforming prior authorization
3. Allowing physicians to own and expand physician-led hospitals
4. Creation of site-neutrality rules for outpatient, office-based treatments
5. Reducing the regulatory burdens on physician practices
Decades of policy have put the thumb on the scale in favor of large corporate interests and insurance carriers. If we can even the playing field, costs will come down, physicians will return to private practice and patients will have more access.
Q. How are advocacy efforts pushing for prior authorization and payment reform?
AB: Prior authorization and payment reform are clearly two of our primary focuses. From a payment reform standpoint, medicine has coalesced around a focused message that we need inflationary updates like everyone else in healthcare. Currently, hospitals, ASC and other healthcare facilities receive positive updates annually. Physicians are confined by budget neutrality and do not have a guaranteed increase. This has led to instability in the private market causing physicians to reluctantly sell their practices. Every day I hear doctors frustrated with this reality but with no real escape. Our focus is on requiring positive updates that reflect the actual cost of doing business and also updating rules around budget neutrality to ensure a more stable practice environment.
Prior authorization received a lift from CMS in January of this year when rules were finalized that implemented many of the initial legislative efforts surrounding data collection, prompt responses, and electronic filing. While regulatory efforts are helpful, ideally we have legislative language that will memorialize and provide longevity to CMS’ rules. To that end, we are supporting the Seniors Timely Access to Care Act, which has language that mimics the CMS rule. In the long term, we will need to work on expanding legislative efforts to include all insurers (not just Medicare Advantage) in addition to gold card style laws.