In The News

Final Spending Bill Falls Short in Offsetting Fee Schedule Cuts


The omnibus package likely to pass provides insufficient relief, but it does include several wins for the profession in other areas.

In a disappointing response to advocacy that brought the concerns of millions of health care providers to Capitol Hill, the U.S. Congress is poised to approve an end-of-year spending package that fails to fully restore cuts included in the 2023 Medicare Physician Fee Schedule. Rather than provide the needed full 4.5% in funding that would offset reductions in the conversion factor, lawmakers opted for a smaller 2.5% increase this year and an even smaller 1.25% increase in 2024. The resulting cuts will affect 27 specialties, including physical therapy.

The spending decision was included in sweeping omnibus legislation that incorporates elements of multiple bills whose fates hadn't been resolved. While the resulting last-minute legislative mixed bag is short on fee schedule fixes, the bill does include APTA-supported gains in other areas including telehealth, workforce diversity, lymphedema treatment, and the role of PTs and PTAs in the Department of Veterans Affairs. 

'Failure to Fully Commit to Protecting Patient Access'

For the health care provider community, the most significant feature of the omnibus package — the provision of a 2.5% conversion factor funding increase rather than the needed 4.5% infusion — was the final chapter in a yearlong fight to convince Congress to once again intervene to buffer the harm included in the upcoming Medicare Physician Fee Schedule.

As it has for the past two years, in 2022 the U.S. Centers for Medicare & Medicaid Services finalized a fee schedule for 2023 that offsets increases to payment for codes related to evaluation and management with significant cuts to the conversion factor, a key element used in determining payment associated with codes used by a wide range of providers.

APTA and 100 other provider and patient organizations joined in an effort to press Congress to provide a 4.5% spending increase to fully offset the fee schedule cuts. In the end, rather than stepping in at the 11th hour to provide full or nearly full offsets as it did for the past two years, Congress opted to scale back the relief. 

While the 2.5% funding increase will lessen the severity of the cuts, providers will still be left to deal with reductions just as the country's health care system continues to recover from the coronavirus pandemic. The response from provider groups was immediate, with organizations such as the American Medical Association and the Surgical Care Coalition expressing their frustration at Congress’ failure to provide the full 4.5% funding.

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Seasonal Influenza Health Alert

Seasonal influenza activity is high across the United States. The Centers for Disease Control and Prevention (CDC) estimates that in the 2022-2023 season to date, there have been at least 13 million illnesses, 120,000 hospitalizations, and 7,300 deaths from influenza (Weekly U.S. Influenza Surveillance Report | CDC). While the Food and Drug Administration (FDA) has not indicated shortages of oseltamivir (generic or Tamiflu) in any of its forms (capsules, oral suspension), CDC has received numerous anecdotal reports of availability issues for generic oseltamivir in some locations [1]. This may continue to occur in some communities as influenza activity continues.

This Health Alert Network (HAN) Health Advisory provides clinicians and public health officials with guidance for prioritizing oseltamivir for treatment and information on other influenza antivirals that are recommended for treating influenza in areas where oseltamivir is temporarily unavailable.


White House to Resume Program Sending Free COVID Tests by Mail

The Hill | By Nathaniel Weixel

The Biden administration is restarting its program to send free COVID-19 testing kits through the U.S. Mail to any households that request them.

The White House on Thursday said households can begin ordering a total of four at-home tests from the website to be mailed directly to them for free, regardless of how many tests they have ordered previously. 

The tests will start to ship out the week of Dec. 19th, according to an administration official.

The White House first began sending out the kits last January during the peak of the omicron wave, but the program was halted at the beginning of September due to a lack of funding from Congress. Administration officials at the time indicated they were concerned the stockpile of tests would run out before the winter.

By the time the program ended, the federal government distributed an estimated 600 million tests.

Now, the program is restarting as part of the White House’s broader winter preparedness plan. According to a senior administration official, leftover American Rescue Plan money is being repurposed to purchase and distribute additional tests.

The administration has requested about $10 billion in COVID response money from Congress as part of the year-end government funding bill, but the prospects of it being included amid major GOP opposition are slim.

Public health officials have repeatedly warned that the U.S. will likely face another wave of COVID-19 infections as the weather gets colder and people travel and gather for the holidays. White House officials have said they are prepared for any potential surge in infections, noting that widespread vaccinations have made the virus far less disruptive than it was two years ago.

But it doesn’t seem to be convincing a checked-out public to get vaccinated. New COVID-19 booster shot uptake remains extremely low heading into the Christmas and New Year’s holidays, with fewer than 14 percent of the eligible population receiving a shot. In the meantime, infections, hospitalizations and deaths are all rising, according to data from the Centers for Disease Control and Prevention

Aside from mail-order tests, the winter plan will include distributing tests and masks at more locations, the White House said. 

Nursing homes and long-term care facilities will also see additional resources and flexibilities to help boost lagging vaccination rates, including allowing nursing home staff to administer shots. 


U.S. Healthcare-Spending Growth Slowed in 2021, Federal Report Finds

Wall Street Journal | By Stephanie Armour
The analysis from the Centers for Medicare and Medicaid Services says national healthcare spending grew in 2021 to $4.3 trillion. 
Overall health spending had risen by 10.3% in 2020, and the more moderate increase last year was largely driven by a drop off in federal spending related to Covid-19. In fact, federal health spending fell 3.5% in 2021 to $1.46 trillion after surging almost 37% in 2020. At the same time, there was an uptick in spending on insurance coverage and healthcare services in 2021.
The healthcare share of the gross domestic product was 18.3% in 2021, down from 19.7% in 2020.
Medicare spending swelled 8.4% in 2021 after rising by 3.6% in 2020, with a strong rate of spending growth in Medicare private plans and increases in spending on hospital care and doctor and clinical services. 
Medicaid, a state-federal program for the low income and disabled, saw a 9.2% increase in spending in 2021. The pace was similar to 2020 but far higher than the average 2.9% rate of spending growth in the 2017 through 2019 period. The spending rate was driven by faster enrollment in Medicaid and a restriction on states’ ability to disenroll enrollees during the pandemic public-health emergency. 
Private-health-insurance spending rose 5.8% in 2021 after a decline of 1.1% in 2020, and accounted for 28% of total healthcare spending last year—an uptick largely due to more enrollment and use by consumers. Most of the growth in enrollment came from the individual market, as more people signed up for coverage because Congress passed legislation to enhance Affordable Care Act premium subsidies. Employer-sponsored health insurance saw its second consecutive year drop in enrollment. 
Out-of-pocket health spending last year rose by 10.4%, marking the fastest rate of growth since 1985, as people resumed visiting doctors and obtaining elective health procedures once the impact of the pandemic lessened. The faster growth was especially notable in dental care, which saw spending jump 18% in 2021 after a drop of 11% in 2020.
Retail-prescription-drug spending rose 7.8% to $378 billion in 2021, a brisk pace compared with the 3.7% spending growth rate in 2020. Private health insurers, Medicare, Medicaid, and consumers’ out-of-pocket spending all experienced the faster growth, with less spent on newly available generic medications compared with spending on newly available higher-priced brand name drugs. 
Overall spending on hospital care, meanwhile, rose 4.4% to $1.3 trillion in 2021 as use of services increased after Covid-19 restrictions on elective procedures and less urgent care eased. Physician and clinical services saw a 5.6% increase in spending last year as patient visits picked up again.


CDC Expands Updated COVID-19 Vaccines to Include Children Ages 6 Months through 5 Years

Following FDA action, [December 9, 2022] CDC expanded the use of updated (bivalent) COVID-19 vaccines for children ages 6 months through 5 years. Children ages 6 months through 5 years who previously completed a Moderna primary series are eligible to receive a Moderna bivalent booster 2 months after their final primary series dose. Children ages 6 months through 4 years who are currently completing a Pfizer primary series will receive a Pfizer bivalent vaccine as their third primary dose.

Updated COVID-19 vaccines are formulated to protect against some of the more recently circulating viruses.

Most importantly, COVID-19 vaccines are critical to providing ongoing protection as immunity wanes and the virus continues to mutate.

The vast majority of children in this age group have not received any doses of a COVID-19 vaccine. CDC is working to increase parent and provider confidence in COVID-19 vaccines and improve uptake among the 95% of children who are not vaccinated or who have not completed the COVID-19 vaccine primary series. Parents should talk to their child’s health care provider to ensure their child is up to date on their COVID-19 and other vaccines.

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