Case Study – Working with Congress to Prevent Harmful Medicare Reimbursement Cuts

The Client Need

A coalition of physicians and other stakeholders wished to advocate against proposed reimbursement cuts in the Medicare Physician Fee Schedule for the provision of services utilizing a particular medical device. These cuts posed a significant risk to the physicians and the treatment facilities, with several fearing the cuts would force them to cease providing these services. The coalition sought a comprehensive strategy to dissuade the Centers for Medicare and Medicaid Services (CMS) from implementing these damaging cuts.

K+A’s Solution

Through collaboration with the client, K+A created a bipartisan, bicameral influence map: identifying Members of Congress where the coalition had physician members and/or a treatment facility and cross-referencing the map with Members of Congress serving on committees with jurisdiction over Medicare. By leveraging our existing relationships with key lawmakers, we were able to expand the scope of our initiative to additional Congressional offices as well.

After developing a comprehensive list of lawmakers from both political parties and from both the House and Senate, we led a coordinated campaign to educate them on the therapy provided by the device, the proposed reimbursement changes, and the potential impact to their district or state if the cuts were to take effect. We worked with the coalition members to stress the importance of providing Medicare beneficiaries with access to this therapy with these policymakers.

We provided Congressional offices with materials, including background information, talking points, and draft letters, to guide their discussions with CMS officials and effectively advocate against the proposed changes. We also monitored the Administration’s efforts to promulgate the Physician Fee Schedule final rule, and prepared for further engagement with Congress in the event of any potential decision by the agency.

The Outcome

Numerous Members of Congress weighed in with CMS to oppose the reimbursement changes. The agency ultimately reversed its position, and in the Physician Fee Schedule final rule CMS opted to forgo the proposed reimbursement cuts. We informed the client of this development shortly after the release of the final rule, and worked with the client to inform Members of Congress who had intervened on our behalf. The relationships developed for the client through this exercise continue to provide value as additional challenges arise.