Healthcare Snapshot - January 2025

In late 2024, Congress passed the American Relief Act, 2025, which includes several health care provisions aimed at enhancing public health services and extending key Medicare programs. Notably, the Act provides continued funding for community health centers, the National Health Service Corps, and teaching health centers that operate graduate medical education programs. It also extends special diabetes programs and maintains increased inpatient hospital payment adjustments for certain low-volume hospitals. Additionally, the legislation prolongs the Medicare-dependent hospital program and sustains add-on payments for ambulance services, ensuring that essential health services remain accessible to vulnerable populations.

Despite these advancements, several significant health care priorities advocated by PSW and other ACO stakeholders were not addressed in the final legislation. NAACOS urged Congress to extend Medicare's Advanced Alternative Payment Model (AAPM) incentive payments and to ensure that qualifying thresholds for these models remain attainable. These incentives have been instrumental in supporting over 500,000 health care providers in transitioning to value-based care models, which have collectively generated more than $28 billion in gross savings for Medicare over the past decade.

Additionally, stakeholders highlighted the need to address scheduled cuts to Medicare's physician payments, advocating for updates that reflect inflationary pressures. The current fee-for-service physician payment system has resulted in payment reductions over the past five years, compounded by rising operational costs. Without legislative action to mitigate these cuts, there is apprehension that physicians and other health care providers may face financial strains that could impede their ability to deliver high-quality, patient-centered care, particularly in rural and underserved communities.

PSW, alongside NAACOS and other coalitions, continue to advocate for the advancement of AAPM incentives and a revamping of MACRA payment policies.

A 55-year-old woman with a history of chronic pain syndrome, fibromyalgia, recurrent major depressive disorder, iron deficiency anemia, asthma, and COPD faced significant challenges managing her health. Over the past year, she visited the emergency department nine times and was hospitalized once. She was referred to care management services to help address these issues.

During her first conversation with her nurse care manager, the patient revealed she had stopped taking her prescribed COPD medication. A $2,000 bill from her specialty pharmacy and the difficulty of resolving the issue while juggling work had left her feeling defeated.

The nurse care manager immediately took action, contacting the pharmacy on the patient’s behalf to better understand the situation. The nurse was able to help the patient apply for a copay assistance program. Once approved, the nurse assisted her in providing the necessary information to get the card. With the copay card in place, the balance was able to be paid in full, and the patient was able to access her medication at no further cost