Pay, prior authorizations top providers' policy agenda for 2025

There may be a new president in the White House and a new majority on Capitol Hill, but major healthcare provider trade groups remain mainly focused on perennial issues as they seek to influence policymaking in 2025.

Medicare reimbursements, Medicaid funding, health insurance prior authorization requirements and workforce issues top the policy agendas for organizations representing hospitals, physicians and long-term care providers, according to a review of policy briefs and letters trade associations have issued in recent weeks.

Related: Bipartisan bill offers big Medicare physician pay hike

“The next two years will offer opportunities to continue the important work of improving healthcare choice and affordability for patients across the country,” the Federation of American Hospitals advocacy agenda says.

Hospitals

Hospital groups share a handful of priorities, such as maintaining or increasing Medicare reimbursements, sustaining federal Medicaid funding, rescinding the nursing home staffing minimums regulation and cracking down on prior authorizations.

The Federation, which represents investor-owned health systems, and the American Hospital Association place special emphasis on Medicare reimbursement, the lifeblood of the U.S. hospital sector.

“Any reductions to Medicare payments would further contribute to Medicare’s chronic failure to cover hospitals’ cost of caring for beneficiaries,” says the Federation’s agenda, which it sent in a letter to House Speaker Mike Johnson (R-La.), House Minority Leader Hakeem Jeffries (D-N.Y.), Senate Majority Leader John Thune (R-S.D.) and Senate Minority Leader Chuck Schumer (D-N.Y.) last month.

The same goes for Medicaid funding, which could be on the chopping block as the GOP congressional majority and President Donald Trump look for trillions of dollars in spending cuts to finance an extension of tax breaks for corporations and wealthy households.

For example, America's Essential Hospitals, which represents safety-net facilities, wants Congress to continue allowing providers to boost state Medicaid funding through so-called state-directed payments, while Republicans may ban them.

“We hope to continue to work with the Centers for Medicare and Medicaid Services to ensure that Medicaid supplemental payment policies continue to support our essential hospitals’ work in their communities,” Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, wrote in an email.

The AHA and the Federation each highlight their opposition to site-neutrality payment policies for outpatient care, which would bar hospitals from receiving more Medicare reimbursement than other providers for the same procedures.

CMS and Congress should maintain Disproportionate Share Hospital payments to facilities serving large numbers of low-income patients, according to the Federation and the AHA. The 340B Drug Pricing Program, which allows hospitals serving low-income patients to buy discounted pharmaceuticals, should also be protected, the AHA says.

The AHA and the Federation want Congress to extend enhanced health insurance exchange tax credits, which are due to expire at the end of the year.

The AHA and the National Rural Health Association are among those provider groups that have identified reducing the burden of prior authorizations as a key issue.

Hospital groups also agree that Congress should address health professional staffing shortages, specifically by raising Graduate Medical Education funding to create more slots. CMS opened up 200 Medicare-funded slots in November to carry out the first increase since 1997, but providers continue to warn that demand outstrips supply.

Physicians

A new Medicare physician payment system and actions to address this year's reimbursement cut are front of mind for organizations representing doctors and medical practices, such as the American Medical Association, the American Academy of Family Physicians and the Medical Group Management Association.

“The time is now to enact targeted reforms ... and provide physicians with a payment update that reflects inflationary pressure,” AMA President Dr. Bruce Scott wrote in a blog post Jan. 22.

All three groups want additional prior authorization oversight. Almost 90% of practices reported that prior authorizations strain their workloads and finances, according to the MGMA’s most recent survey.

Physician organizations also want Congress and CMS to remain focused on developing and refining value-based care arrangements. The AMA, for instance, favors physician-led payment models.

The AAFP and the MGMA call on CMS to streamline quality reporting requirements and reduce the load on medical practices.

In addition, the AMA and the MGMA want Congress to extend Medicare reimbursement for telehealth services and the MGMA supports policies that would facilitate artificial intelligence in group practice settings.

Long-term care

The American Health Care Association/National Center for Assisted Living and LeadingAge prioritize strengthening the workforce.

“We will continue to advocate for our profession to ensure providers are equipped with the resources necessary to provide consistent high-quality care to residents, both now and in the future,” AHCA/NCAL President and CEO Clif Porter wrote in an email.

LeadingAge, which represents nonprofit post-acute care and home- and community-based services providers, and the AHCA/NCAL have strongly objected to the nursing home staffing rule CMS issued last year under President Joe Biden and filed a lawsuit to eliminate it.