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A House hearing on ways to increase payments and cut red tape for physicians who treat Medicare patients also included a discussion over whether Republicans wanted to cut Medicare benefits for seniors.

"Just yesterday, in a speech on the House floor nominating [Rep.] Jim Jordan (R-Ohio) as their candidate for Speaker, Republicans expressed concern with Medicare's finances and cited their support for Jordan because of his desire to make devastating cuts to our nation's social safety net healthcare programs," Rep. Frank Pallone (D-N.J.), ranking member of the full House Energy & Commerce Committee, said Thursday at the Energy & Commerce Health Subcommittee hearing.

"It's unfortunately a pattern we see over and over again from Republicans, pushing forward expensive policy changes and then demanding devastating spending cuts to Medicare that would increase costs for seniors," Pallone said. "The truth is Medicare is not broke; it does not need major changes, and it certainly does not need terrible Republican ideas to cut benefits, raise the retirement age, or increase seniors' cost-contributions."

Health Subcommittee chairman Brett Guthrie (R-Ky.) disputed Pallone's characterizations. "I appreciate the passion from my friend from New Jersey," Guthrie said, referring to Pallone, "but we are not proposing anywhere in there to take benefits away, nor are we proposing to [have seniors] pay more." Rather, Republicans were upset that the savings anticipated from changes to Medicare that were part of the Inflation Reduction Act "were spent outside of Medicare to enhance subsidies to health insurance companies. So people need to understand we were just as passionate fighting that" as Democrats were passionate in fighting for their issues, Guthrie said.

Pallone was also not happy about the hearing process, which involved consideration of 23 different bills. "My Republican colleagues shared a vast majority of the discussion drafts we will be discussing less than a week before the hearing [notice was issued]," he said. "Many of these drafts are still half-baked. And given the broad array of topics and bills, I am disappointed that we did not have adequate time to fully vet some of these policies and provide Democratic input from the beginning."

The bills under discussion included a draft measure dealing with how the Medicare Physician Fee Schedule is set. The reimbursement rates under the fee schedule are set using a "conversion factor" -- a multiplier that Medicare applies to relative value units (RVUs) to calculate reimbursement for a particular service or procedure. Under the bill, which was proposed by Rep. Michael Burgess, MD (R-Texas) and cosponsors, the HHS secretary would be required to update -- at least every 5 years -- the part of the RVU that takes into account the expense of running a medical practice, including clinical wage rates, prices of medical supplies, and prices of equipment. The draft also limits the amount of variation in the conversion factor, which is set annually.

"We've all seen what's happened to the cost of labor," said Burgess. "California passed a minimum wage for healthcare workers [of $25 per hour]. For doctors who are in practice, they are competing for workers in that same pool of laborers. The word 'unsustainable' continues to creep into the conversation ... I hope we can get behind some of these common-sense solutions."

Some committee members, mostly Democrats, were upset about the bills that were not included for consideration at the hearing. "We're notably not considering , to provide a Medicare physician payment update tied to [healthcare] inflation," said Rep. Anna Eshoo (D-Calif.), the subcommittee's ranking member. "I think that that is really a must." Rep. Mariannette Miller-Meeks, MD (R-Iowa) agreed. "I've done military medicine and I've been employed by a hospital physician, which is why I was very proud to cosponsor H.R. 2474," said Miller-Meeks, who worked as a nurse before going to medical school. "I feel very strongly about this legislation."

Miller-Meeks asked hearing witness Steven Furr, MD, president-elect of the American Academy of Family Physicians, whether his organization supported that legislation. "I don't know any physician organization that does not support that," Furr replied.

Value-based care also came under consideration. Rep. Kim Schrier, MD (D-Wash.) said she was disappointed that the was not being considered. "It's a bipartisan bill that would help increase participation in value-based programs that will improve the quality of care and health outcomes, all while lowering costs," she said. "This bill would extend incentive payments for Advanced Alternative Payment Models, which help [providers] transition to a model that focuses on patient health outcomes."

She added that another bill, still in draft form, that the subcommittee is considering also extends the incentive payments, "and the problem is that it would be at a lower level and with a 5-year retroactive cap, and I'm really concerned about placing this kind of cap on providers. I think it will limit the ability to help providers adapt and to implement these programs."

Rep. Bill Johnson (R-Ohio) touted a bipartisan bill to allow Medicare patients to receive drugs through the mail. "During the COVID 19 pandemic, patients were able to have their medications mailed directly to them from their doctor," he said. "For folks in rural Ohio, whom I represent, this was a godsend. No longer did they have to drive to Cleveland or Columbus or Pittsburgh to pick up their cancer medications from their oncologist."

But that flexibility ended with the expiration of the COVID-19 public health emergency, so the bill, , "would make permanent those waivers from the pandemic allowing patients to receive medications through the mail," Johnson explained. Hearing witness Debra Patt, MD, PhD, executive vice president of a Texas oncology group, praised the measure. "If we were able to mail-order those drugs to patients, they would be able to seamlessly continue their cancer care or other care," she said.

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