James Lankford ‘We Need To Incentivize’ The Next Generation Of Doctors

6 months ago

Earlier this month, Sen. James Lankford (R-OK) questioned experts on the security of the medical financial system during a Senate Finance Committee hearing.

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Transcript

00:00 Senator Lankford is next. Chairman, thank you. Thank you all for spending your time

00:04 here. A lot of things you could be doing today. Thanks for being here. I'll be a

00:08 part of it. We've all talked about the physician fee schedule and the struggle

00:13 with that. That is frustrating for all of us, but especially for physicians on it. I

00:19 am one of the folks that thinks we need to incentivize more doctors coming into

00:23 the process rather than the next generation of folks thinking I don't

00:27 want to do that to be able to deal with the hassle of that all the time. I'd like

00:31 for more folks to be able to come into the process. We have several things

00:34 we've kind of highlighted on. I'm not going to go through as well, but the

00:37 critical access hospital piece has been a challenge in my state, you know, a

00:41 state that's split evenly rural and urban and trying to be able to manage

00:45 that. We have a bill, Rural Hospital Closure Relief Act, which gives some

00:48 states some flexibilities. We have not talked about physician-owned hospitals,

00:52 but that continues to be an issue long-term with allowing physician-owned

00:56 hospitals to continue to be able to grow and to be able to take care of their

00:59 patients. I do want to talk a little bit about this prior authorization. Dr. Furr,

01:03 you've mentioned this a couple of times as well. We have hospitals in my state

01:06 that are just no longer taking Medicare advantage because of the prior

01:10 authorization issue on that. How does that get resolved? What do you see as a

01:14 solution to that? And you're seeing physicians refusing to take them along

01:20 with that, and it's a huge hassle. It takes a huge amount of time. I think

01:24 physicians need to be at a practice, and again, it's for big budget items. I

01:28 don't have a problem with prior authorization, but when it comes to basic

01:31 drugs and basic things we need to do. Just to give you a perfect example, if I

01:35 got a patient with acute abdomen, it's easier to send them to the emergency

01:39 room because they don't have to get a prior authorization to do their CT scan

01:42 than for me to do it in my office because it could take me a day or two to

01:45 get that done. So the prior authorizations, which are meant to

01:48 control costs, in many ways are actually increasing costs. And sometimes the best

01:52 drug might be a more expensive drug, but it's better for the patient because it

01:57 might lower their cardiovascular risk along with taking care of their

02:00 diabetes or their hypertension. So those are all issues with prior authorization

02:04 that keep us from providing the best care that we can and actually drive up

02:08 cost. Okay, that's helpful to be able to get context. Ms. Matthews, you talked a lot

02:12 about the value-based care and some of the issues and the innovations that are

02:16 there with 34 ACOs that are operating in Oklahoma. They've saved Medicare about

02:22 $50 million, best we can guess the last couple of years on it, but I do want to

02:26 give an example of this. We have one ACO in Oklahoma that saved almost

02:31 $9 million just in 2022, but they missed the minimum savings rate by 0.17%.

02:41 So here's the challenge. What recommendations would you make on making

02:46 changes to the shared savings plan to make sure that we've got more ACOs and

02:49 then we don't actually frustrate entities that are trying to get into this?

02:52 I think building in the stability for the long-term commitment to the AAPM and

02:59 engaging with CMS and Congress on the importance of accuracy around

03:06 benchmarking. You know, we had through COVID very, very different utilization

03:14 patterns and those were realized very differently depending on the state that

03:18 you lived in as well. And so when we look at creating national and regional

03:22 benchmarks, there is some implication from the time of in the benchmarks from

03:27 COVID just because the utilization and historical expenditures. So that

03:32 certainly created some of those methodologies. The other thing is we're

03:35 learning. We're learning so much and so I think I applaud the work that we're

03:41 doing to take a look at what we called the lessons learned in the models and

03:45 how do we continue to iterate on those to be more successful for the models in

03:50 the future. Okay, I want to ask about something we've not talked a lot about today and

03:55 that is hospice care and how it interacts with Medicare. Just for the

03:59 care of patients and individuals, I know that's set up typically for the last six

04:02 months of life. Not always. We have a rather famous example of that in

04:06 President Carter that I think has been in hospice care 14 months I think at

04:11 this point or approaching that. Um, the design of it is to be able to help

04:18 with end of life to be able to help through families to increase some

04:22 benefits in some areas and decrease them and others. I walked through this

04:25 recently. I won't go through all the story on this with my own mom was a

04:28 Parkinson's patient for years who passed away a year and a half ago. But some

04:33 physicians towards the end were talking to me about hospice care and we're

04:36 walking through that as a son and a mom and a physician and I was advised, well

04:42 you know what if hospice care is not working out and you want to come see a

04:45 specialist or whatever it may be, you can just drop it, go back into Medicare, be in

04:49 Medicare for a while, then drop that, go back into hospice care and I suddenly

04:53 understood there's a loophole in the system that's literally being built in

04:57 and it's being exploited. I personally watched firsthand in that. Other issues

05:03 that are like that, what would you recommend on changes on hospice care and

05:06 ways that we can help families in those moments whether that be in the value of

05:11 it or what needs to be done to be able to improve hospice? I'm open to anyone

05:16 who wants to contribute. I'm happy to contribute. Thank you so much for the

05:22 question. So I think a couple of things to highlight here. I think first you know

05:26 one thing that's actually quite interesting is another federal program

05:29 the Veterans Health Administration provides a benefit to veterans where

05:33 when they opt into hospice they actually don't have to forego regular care, life

05:39 extending care and I believe the latest estimates from the VA is that that is a

05:43 cost-saving program for them still because it allows palliative care

05:47 clinicians to come and educate patients and align care with their preferences

05:50 without what might seem to a family or a patient a somewhat draconian thing which

05:56 is I've got to walk away from opportunity to other care. So that's

05:59 that's one thing to contemplate. The other thing is our hospice payment system also

06:04 has opportunities for improvement. There are some peculiar incentives in that we

06:09 have caps on how much hospice and the sort of duration of care that hospices

06:14 can give. Those create distortions so it's unclear that those caps are

06:20 actually doing well for our beneficiaries and that's something else

06:22 that could be contemplated.

James Lankford ‘We Need To Incentivize’ The Next Generation Of Doctors

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