Advocacy Update

April 2024

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American Academy of Otolaryngology-Head and Neck Surgery

AAO-HNS 2024 Legislative Priorities

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• Promoting long-term, sustainable and fair Medicare reimbursement reforms
• Reducing administrative burden and promote patient access to care
• Challenging scope-of-practice expansions that threaten patient safety

Medicare Reimbursement

Our position: Congress needs to reform the Medicare payment system to create a long-term, sustainable, and fair solution for Medicare physician reimbursement.

• A 3.4% Medicare physician payment cut went into effect on January 1, 2024.
• From 2001 to 2024, Medicare physician payment has been cut 29%, adjusted for inflation (see graph)
• In March, Congress passed legislation to reduce by about half (1.68%) of the 2024 3.4% Medicare physician pay cut. The updated conversion factor for the remainder of the calendar year is $33.29 (an increase from $33.07). This update, which is not retroactive, went into effect on March 9. 
• In February, a bipartisan group of Senators announced the formation of a Medicare payment reform working group. The goal of this group is to investigate and propose long-term reforms to the Medicare physician fee schedule.
• Congress, for the first time in almost a decade, is actively considering solutions to reform the current Medicare physician payment system.
• The AAO-HNS is actively lobbying for Congress to pass legislation (such as H.R. 2474) to protect Medicare patients’ access to care and provide stability for physicians and their practices.

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Reducing Administrative Burden

Our position: Congress should eliminate burdensome administrative hurdles that limit patient access to timely care by passing the Safe Step Act (S. 652 / H.R. 2630) and reintroducing the Improving Seniors’ Timely Access to Care Act.

• On January 17, 2024, CMS finalized regulations on prior authorization which mirror many of the reforms contained in the Improving Seniors’ Timely Access to Care Act. 
• Per the final rule, payers (Medicare Advantage Plans & other federal health plans) are required to send prior auth decisions within 72 hours for urgent requests and 7 calendar days for non-urgent requests, include specific reasons for denials, and publish prior authorization metrics annually.
• CMS estimates the requirements will lead to cost-saving efficiencies, saving doctor practices and hospitals more than $15 billion in 10 years.
• The Academy, along with 60+ medical organizations, endorsed the Safe Step Act, which would reform step-therapy policies by creating an expedient & medically reasonable step therapy exceptions process.
• We expect regulations to be a significant avenue for reform moving forward but are still pursuing a legislative fix.

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New Add-on CPT Code G2211

• In January, the new CPT code G2211 was activated for reimbursement as finalized in the 2024 Medicare Physician Fee Schedule (MPFS).
• G2211 is an evaluation and management add-on code to better account for the costs associated with E/M visits and longitudinal care in a provider-patient relationship.
• G2211 can be listed separately in addition to office/outpatient E/M visits for new or established patients.
• Can be reported by all specialties.
• DO NOT use when the E/M visit is reported with a payment modifier.

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• At this time only Medicare is reimbursing for this code, at a rate of $16.04.
• For additional information and cases for use:
• CPT for ENT Article 
• AAO-HNS frequENTcy podcast 

Scope of Practice Issues

Our position: Physician-led health care teams provide the best approach for providing high-quality specialty care to patients.

• In the 118th Congress, the Medicare Audiology Access Improvement Act (S. 2377/H.R. 6445) was introduced. 
• The legislation would inappropriately grant audiologists unlimited direct access to Medicare patients and ultimately threaten patient safety by undermining physician-led team care.
• The AAO-HNS spearheaded a letter signed by 111 national, state, & local physician organizations expressing strong opposing to S. 2377 / H.R. 6445
• Contact your members of Congress today to oppose this bill!
• We are fighting legislation in multiples states that expand the scope of practice for audiologists and hearing aid dispensers

Patients prefer physician-led-care

Stop CMV Act

• A group of bipartisan Senators & Representatives introduced the Stop CMV Act (S. 3864 / H.R. 7542), which would authorize federal funding for congenital cytomegalovirus (cCMV) screening programs that improve early detection and intervention.
• cCMV is the cause of about 25% of childhood hearing loss. Despite its incidence, awareness remains low among the public and health care workers. 
• Strong bipartisan support for the legislation will pressure Congressional leadership to advance the legislation before the end of the year.
• Contact your members of Congress and urge them to support the Stop CMV Act!

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Michigan Issues – Currently Monitoring

• Scope of Practice
• Multiple bills impacting physician assistants, medical assistants, and nurse practitioners 
• Hearing Aids
• HB 4963 / HB 4944: mandate insurance coverage for children 
• Telemedicine
• HB 4131: insurance coverage of telemedicine services
• Other
• HB 5612: medical practice by graduates of international medical schools

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How can I get involved?

• Join the ENT Advocacy Network
• Receive news and updates from the AAO-HNS Advocacy Team
• Learn about opportunities to participate in advocacy events with your peers
• Participate in legislative grassroots campaigns

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• Join the State Trackers Program
• Help monitor, review, and advocate on legislation impacting the specialty & patients in your state
• Participate in monthly evening calls to share policy updates and identify emerging legislative trends 

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• Support ENT PAC*
• ENT PAC is the Academy’s nonpartisan federal political action committee
• 100% of contributions go towards supporting our congressional allies, reinforcing their ability to stay in Congress and fight for the needs of our specialty and patients
• The stronger our PAC (dollars raised, number of investors), the stronger our collective voice on our federal legislative priorities

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• Engage with your regional/state otolaryngology societies & partner with state medical societies 

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How can I get involved?

In-District Grassroots Outreach (I-Go)

• Develop a new relationship, or enhance an existing one, with your federal and state lawmakers
• Take advantage of in-person advocacy opportunities
• Host a practice visit
• Meet with congressional staff in the local office
• Attend a political in district fundraiser
• AAO-HNS Advocacy Staff can assist with scheduling and will provide all necessary talking points, materials and assistance
• TELL YOUR STORY!

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Project 535

• Goal: Recruit “key contacts” for all Members of Congress
• 435 Members in the U.S. House of Representatives
• 100 Members in the U.S. Senate
• Purpose: By using coordinated email and phone campaigns, we can improve our outreach to federal legislators when major issues impacting the specialty are debated by Congress.
• Sign up at www.entnet.org/advocacy. The commitment is minimal, but the impact is immense!

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Contribute to ENT PAC Today

ENT PAC Disclosure

*Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.