Big Provisions in $1.7 Trillion Omnibus: What Doctors Should Know

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In enacting the 4,000-plus page, end-of-the-year spending package, Washington politicians failed to stop the entirety of scheduled Medicare pay cuts, which will come at a financially precarious time for physician practices left reeling in the COVID-19 pandemic’s third year.

Because of that, physicians will face a 2% cut in Medicare payment in 2023, and 2024 will bring at least a 1.25% cut. Nevertheless, the $1.7 trillion bill signed by President Joe Biden does include a number of important AMA-supported provisions that physicians should know about.

Among other things, the omnibus bill extends:

• Telehealth payment and regulatory flexibilities for two years. Supporting telehealth is an essential component of the AMA Recovery Plan for America’s Physicians. 

• The alternative payment model bonus at 3.5% and delaying the scheduled increase in the revenue threshold.

• The Medicare Acute Hospital Care at Home waiver for two years.

• The increased Medicaid match rate for Puerto Rico for another five years.

The new law also adds: 

• An exception to the Stark law to allow hospitals and other entities to provide evidence-based programs to boost physician resiliency and mental health and prevent suicide among physicians.

• A permanent option for states to provide Medicaid coverage for 12 months postpartum.

• 200 more graduate medical education positions, 100 of which will be in psychiatry or psychiatric subspecialties—a small, but essential step to address physician shortages.

• A requirement for Medicare Part B coverage of compression garments to treat lymphedema.

The spending package also incorporates central provisions of the:

• “Retirement Parity for Student Loans Act,” which allows employers to make matching retirement-plan contributions for physicians and other workers as if their student-loan payments were salary reduction contributions. 

• “MAT Act” to permanently repeal X-waiver requirements for the prescribing of buprenorphine for opioid-use disorder. Learn what’s at stake in ending the overdose epidemic. 

• “NOPAIN Act,” which directs the Centers for Medicare & Medicaid Services to provide separate payment for nonopioid treatments used to manage pain in the hospital outpatient departments and ambulatory surgery center settings.

• “NIH Clinical Trial Diversity Act,” which sets out requirements to increase the diversity of clinical trial participants and foster participation in clinical trials.

• “Public Health Prevents Pandemics Act” to boost pandemic preparedness.

The failure to stop all of the Medicare physician payment cuts represents a deliberate decision by Congress to move away from the precedent set in 2021 of providing relief from budget-neutrality cuts.

Because of this, Congress has an increased responsibility to make important reforms to the Medicare physician payment system to ensure regular updates that reflect increases in the cost of providing care, like those included in payment systems for all other Medicare providers.

This year, the AMA will continue challenging Congress to work on systemic reforms and make Medicare work better for you and your patients.

Visit the Physicians' Grassroots Network for more information on how to take action on this, and other important issues, impacting medicine.