Anders Gilberg 00:00:00 My recollection was Elon Musk started tweeting about it, and within a couple of days, 900 pages of that 1000 page bill were scrubbed.

Keith Reynolds 00:00:17 Welcome to Off the Chart A Business of Medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Reynolds, and this week we've got a conversation between myself in front of the show Anders Gilberg, senior vice president for government affairs with GMA. We're talking about the second Trump administration and what it means for healthcare and what the organization has on its lobbying wish list. Today, we have honors. Gilbert, senior vice president of government affairs. He is, mas man in Washington. How are you doing today, Anders?

Anders Gilberg 00:01:02 Great. Keith. How are you doing?

Keith Reynolds 00:01:03 not too bad. just some, housekeeping. Just so our, our viewers and our listeners know, this interview is happening on Thursday, January 23rd. this is the week of the inauguration. the newly minted, second Trump administration is, barreling in like a lion, we'll say.

Keith Reynolds 00:01:25 it's just so so everybody knows what's where we're at right now. so, Anders, let's start it out real, real vague. Like, what's what's the state of play right now? What do you what are you guys seeing on the ground?

Anders Gilberg 00:01:38 Well, a lot of what we're looking at are things that are left unfinished for physician medical practices at the end of last year. And, also the fact that the agency, the key agencies we work with, typically HHS as well as, CMS, they have no political leadership yet. So we haven't gone through those confirmation hearings. So we have RFK. We have Doctor Oz. so a new set of leaders set to, most likely be confirmed in those positions. And so, as with any administration, we spend a lot of time early on establishing relationships and, making sure our priorities are at least, put forth. So we represent, physician medical practices and, and especially their business interests. And so, it's a I wouldn't say it's a calm before the storm, but it's a little bit of a calm right now because the administration has put on a moratorium on new regulations for the time being.

Anders Gilberg 00:02:41 And, until the machine starts to get revved up, at least Congress will be our focus until, we'll get more on the regulatory side, from the administration.

Keith Reynolds 00:02:54 Okay. And, you know, you mentioned some of the, the personalities who are being bandied about for various, roles in HHS. you know, how do you guys, you know, how do you guys see the prospect of, you know, HHS Director Bobby Kennedy Jr.

Anders Gilberg 00:03:11 Yeah. I mean, it's, it's quite, an interesting kind of, coalition of leaders that President Trump has put together. I only know, RFK from other health care issues, not necessarily the issues we focus on specifically. also, Doctor Oz, I know a little bit about his positions politically when he ran for office and Senate, the United States Senate in Pennsylvania. But, you know, in many ways there are unknown quantities as it relates specifically to, you know, non FDA kind of the more controversial things that are often focused on with respect to RFK and the issues we focus on more, more readily, which would be reimbursement issues.

Anders Gilberg 00:04:03 Deregulation, which I think fits nicely within this, the purview of this administration and, other ways to get the red tape out of delivering health care in this country and ways to make sure that medical groups still have that ability to operate independently if they wish to. So some of those issues are not not as well known. And, but that we'll spend some time over the next few months, working to establish these relationships. And I feel like, we'll have a sympathetic ear, especially on the deregulation side.

Keith Reynolds 00:04:38 All right. so, you know, it's it's a very exciting time. and, you know, everybody's looking forward to what's coming next. But let's take a few steps back. the last Congress sort of left physicians in the lurch. talk to me a bit about that.

Anders Gilberg 00:04:57 Yeah. I mean, we thought we had a reasonably good bill toward the end of the year that dealt with a couple of our really key priorities last year. we're still dealing with the aftermath of some changes that were made in 2020 to evaluation and management codes.

Anders Gilberg 00:05:14 So offices, it codes in increasing those. It caused a budget neutrality adjustment that reduced all the other payments under Medicare. And by reducing what's called the conversion factor and by reducing the conversion factor. Congress delayed that for several years, but now we're dealing with that aftermath. And it ultimately the cut went into effect. So at the end of last year, there was a bill. It was about a thousand pages. It would fund the, the government. you know, it was a budget bill. and it had a lot of what we call extenders, healthcare extenders. So among the key ones that we were looking for was, provisions to wipe out the 2.83% cut in Medicare to the conversion factor that I'm referencing. Also, extending some of the flexibilities for telehealth that expired at the end of 2024. extending that in that bill, it extended it for throughout the year. with the eye toward, making sure that we can study the impact of telehealth on the Medicare program before you permanently, covered telehealth, in Medicare, but still like a longer term extension of those exceptions.

Anders Gilberg 00:06:36 And also, there were some provisions regarding alternative payment models, a 3.5% bonus for practices on their fee for service payments for those practices that were also in advanced alternative payment models in Medicare. So there's a whole list of things that were going to be dealt with, taken care of. And this is where that new environment comes in that I'm not quite as used to. my recollection was Elon Musk started tweeting about it and that caused a bit of an uproar. And within a couple of days, 900 pages of that thousand page bill were scrubbed. And we had a real bare bones continuing resolution with a few healthcare things pass, which will get us to about the middle of March in terms of funding the government. And in terms of the healthcare, things that survived, the physician payment did not. So physicians are now facing, like currently under a 2.83% cut in Medicare. things that survived was a temporary extension of the exceptions for telehealth through March to the end of March. So that did survive. And, you know, we're just sort of regrouping here in terms of the physician lobby, the advocacy groups in Washington to ensure that these are issues that are taken care of here in the in the next month.

Anders Gilberg 00:08:08 You know, ideally, we'd like to see it's happened in the past where, Congress has passed legislation to deal with physician payment and maybe not retroactively apply it, because that can be very administratively burdensome. But prorate the amount that would have been paid out, for the first few months into that final bill for the rest of the year, that happened once, about maybe ten years ago, when we used to deal with something called the Sustainable Growth Rate formula that was also causing a lot of cuts. So, yeah, we're kind of a little bit back to square one with this administration. Now that that bill at the end of the year, Had, largely been scuttled. And so it's Congress is now under the control of both houses of Congress or Republican. some of our champions have retired. Some physicians in Congress have retired. So it's a little bit of a new game. And there's a lot of issues on the table for this March mid-March budget bill. And so that's that's what we're in the mix on right now.

Keith Reynolds 00:09:15 So this is a bit of an inside baseball question. But like how do you as an organization deal with this. You know you mentioned, you know, you guys had a bill that you guys felt very confidently about. And then, you know, Musk tweets about it and things get scuttled. you know, I'm not I'm, you know, not been paying attention to this for the longest time. But, you know, when I was but a lad that, you know, you didn't have billionaires out in California scuttling, you know, 1000 page, you know, bills. So how do you guys approach it now?

Anders Gilberg 00:09:58 Well, we just have to regroup and re-educate. I mean, it is a new Congress. There are new members elected. Some have retired, as I mentioned. And so we're regrouping. We I expect legislation to be reintroduced that we had last year, worked with the American Medical Association and a lot of the physician specialties to address this issue, both from a short term and a longer term perspective.

Anders Gilberg 00:10:22 really what we need is a longer term reform of the physician payment system, and that's what we have the eye toward. It was just fixing that end of year piece last year, so we could have a stable system in which to hopefully negotiate a longer term solution, which everybody, everybody believes that we need some more stability in physician payment. you know, it's. it's probably not productive to go back and think, why did that happen to us and whatnot? It's just the reality of government these days. and, it's a little less certain as perhaps as it was in the past. and with the new president, the priorities change and shift. So, this presidency is unique. It's not unique. But in my experience, having a president who was, you know, had a kind of a gap in between their two terms is is unique for, for me at least. So in many ways, Trump starts this final term of presidency with the impetus to get stuff done now and work with Congress to get stuff done.

Anders Gilberg 00:11:36 Now, his power will never be greater than it is now. you know, a year from now who'll be closer to being, you know, a lame duck president because he can't be re-elected. And he certainly has the bully pulpit at the moment and a mandate through the election. And so it's it's harnessing that enthusiasm for some of these other issues and regrouping and just making sure that MGM's priorities and priorities for physicians are included in some of the vehicles, these legislative vehicles, that, you know, whether it's some of your listeners might have heard that Trump wants one beautiful bill. I think he said, now there's some discussion. Should there be one bill or two bills? I even heard today, maybe three bills. Three beautiful bills. And, I'd say for me at least, the best tactic is to get in the first one, because the second and third one will be harder to pass. So if that is indeed what the way that Congress starts to go about their business. you know, we're regrouping and coming right out of the gate to ensure that our priorities, especially the ones that were left over from last year, are dealt with.

Anders Gilberg 00:12:53 There was one that didn't make the cut last year, which was really disappointing. Excuse me, which was a reform of prior authorization in the Medicare Advantage program and Medicaid and some other federal programs. It's a bill that had, bipartisan support supermajorities in both houses. And the Congressional Budget Office scored it at zero. Should have made it, but didn't. So it's some of those things that were urgently working to include in any the next vehicle, not the third vehicle, but the next legislative vehicle. So still a lot of very important things going on. And then, you know, whether it's Congress or the administration. We do have to wait a bit, like we talked about for the confirmation hearings to finish up. To work with the leadership. But, I mean, there is a strong deregulatory agenda with this administration. I worked on what was called something called patience over paperwork with the first Trump administration. And we were modestly successful at that point in reducing some of that regulatory red tape for medical practices and doctors.

Anders Gilberg 00:14:11 So I think like that'll be a big push after a lot of the early fanfare and those kind of big ticket issues like tax reform and maybe immigration. You know, some of that core, those core issues about the role of government, especially in medicine. Those will come to the fore. And I think we'll we'll have the ability to influence those those ideas and those those.

Sydney Jennings 00:14:40 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Keith Reynolds 00:14:45 Oh, then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again that's patient care online.com. We're we're sort of in in unprecedented grounds with all this. where's MGM's head at? What are you guys what are you guys looking to accomplish? Well.

Anders Gilberg 00:15:12 So those are the short term, like the immediate issues. And each year we put out an advocacy agenda. maybe you could link to it for me, but I can kind of just go through a few of the highlights.

Anders Gilberg 00:15:24 I mean, usually the MGM, we're really focused on the business of of medical practice. you know, we we want medical practices to run efficiently, to be profitable. To reduce that regulatory burden, as I mentioned, with the eye toward allowing physicians to take care of patients and to have better access if you're a patient so you don't have to wait three weeks to get an appointment. we feel like if the business runs smoothly, it health care runs smoothly in the communities in which our medical groups exist. We have 15,000 medical groups in our membership. So protecting that financial viability of medical groups is always sort of on the forefront of our advocacy agenda. There are a few other issues. One I mentioned is reforming prior authorization. so often we do a regulatory kind of, survey of our members. What are the most burdensome administrative and regulatory issues that your practice has faced? Always at the top is always is prior authorization. So we're working to to mitigate that burden, you know, not create a situation where there's more prior authorization, but make it easier for practices.

Anders Gilberg 00:16:37 So, for example, more transparency. Legislation that I was discussing before it would shine a brighter light on insurance practices. So if you're a physician and you're ordering a test, or you're ordering a drug, or you're ordering a procedure, you will know what is subject to prior authorization or not. So it's not a big surprise on the back end that delays and causes potentially negative clinical outcomes. When you're not getting the care, the patient isn't getting the care they need, you know, as fast as they need it. So that's a huge issue for physicians and medical practices. Ultimately, though, our goal is to reduce the number of prior authorizations in this country. Probably not going to do away with it completely. But, you know, we want that decision making authority in the hands of the physicians, other clinicians With the patient. You know, it's part of that relationship not having it overridden by, for profit insurance companies. So that would be another issue. Another another issue that, is just critical to is, there are a lot of, I think, well-intended, efforts to, have physicians report quality measures and to get involved in quality reporting programs in the federal programs of Medicare and Medicaid.

Anders Gilberg 00:18:05 But the Medicare program called the merit based Incentive Payment System, the MIPs program. It's largely seen as an onerous government program. And, I think in many ways, we may just have to get rid of it and reset and try to figure out a new way to work to improve quality in the Medicare program. That isn't just an exercise and administrative hassle recording things that the doctor's already doing, but, you know, sending that all to the federal government. there's also a lot of health information technology issues and issues relating cybersecurity. Some of the things that we experienced with the debacle with Change Healthcare last year, where, I mean, there were just a minority of practices in our membership that weren't affected and claims completely dried up when there was a cyber attack on Change Healthcare, which is owned by UnitedHealth Group. And, and ultimately, even if our members didn't have contracts with change as their clearinghouse, a lot of their clearinghouses that they do have contracts with use change on the back end. So everything just shut down.

Anders Gilberg 00:19:20 And so I think taking a look at both cybersecurity as well as should we really have that degree of consolidated power in our healthcare system Stem to, if there is a situation where there's a cyber attack like that, that it can't just grind the system down to a complete halt. So those are some things off the top of my head. In addition to maintaining access to telehealth, you know, their physician workforce issues that are still always relevant. Those are some of the things at the beginning of each year that we put forward as our advocacy agenda, and people can get that on our website. We also have one pagers where we get into each issue. in terms of our policies on each issue, and if people are interested, they can explore that more. But that's, you know, the 10,000 foot level that, you know, we're looking at as we kind of move into the new administration in Congress.

Keith Reynolds 00:20:14 Well, it certainly seems that, you guys have a partner in, wanting to do things differently.

Keith Reynolds 00:20:21 Okay. Yeah. you know, putting it putting it lightly, it seems that, the the new administration wants to do things differently. All right, Anders, I think that's all the questions I've got for you. Is there anything that you think I'm overlooking? Anything you want to add?

Anders Gilberg 00:20:35 No. It's great to see you again. And I think perhaps, maybe we'll just have to touch base here throughout the year and see how things progress. You know, if nothing else, this administration is going to be a little less predictable than the former one. That could be a good thing. I don't know yet. We'll see. but when we get the players in place and we get through the first few weeks, I think, the pieces will fall into place a little bit more, and I'm happy to come back and chat with you anytime. It's always great to get together.

Keith Reynolds 00:21:03 Oh, absolutely. And, you know, it's, it's easy to forecast doom and gloom, but, you never know.

Keith Reynolds 00:21:10 The sun might shine. Let's hope.

Anders Gilberg 00:21:13 Yeah, absolutely.

Keith Reynolds 00:21:14 All right. Thank you so much. Thanks, Keith. Again. That was honors Goldberg, senior vice president for government affairs with GMA. And as you heard, we'll be checking in with him periodically through the year to get a better view of what's happening in the nation's capital. My name is Keith Reynolds. And on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening and ask that you please subscribe on Apple Podcasts and Spotify just so you don't miss an episode. Also, if you'd like the best stories Medical Economics and Physicians Practice Published delivered straight to your email six days a week. Subscribe to our newsletters at Medical Economics and Physicians Practice. Com. Off the chart A Business of Medicine podcast is executive produced by Chris Maslin and produced by Keith Reynolds and Austin Luttrell. Medical economics, Physicians Practice and Patient Care Online are all members of the MJD life Sciences family. Thank you.