News Clips
Milbank Quarterly: Strengthening the Center for Medicare and Medicaid Innovation’s Approach to Constructing Alternative Payment Models (3/29) – In October 2021, CMMI released its Innovation Strategy Refresh to highlight challenges faced by payment models and suggest new strategic approaches for the upcoming decade. This article provides guidance to CMMI’s vision by examining challenges within CMMI’s strategy for model building and offering solutions to mitigate these issues. These strategies include engaging beneficiaries in alternative payment model (APM) incentives, expanding operational flexibility to improve clinical behaviors, rectifying issues with conflicting model incentives, building voluntary short-term and mandatory long-term incentives to mitigate selection bias, and transitioning to an overriding population-based model to constrain net costs.
Fierce Healthcare: ViVE 2023: Current and former CMMI chiefs reflect on past, future of agency (3/29) – Current CMMI Director Liz Fowler said that while the agency is "not necessarily what we thought it would be" during its creation, it's grown to the point where there are clear throughlines she and her team can follow as they chart the course to new models. "I think we've learned what works and what doesn't," she said. "I think we're past the point of throwing spaghetti at the wall and planting a lot of seeds, and now really trying to home in on what can work." Fowler acknowledged CMMI's mixed track record to date and highlighted the agency's multipronged strategy for the future, which includes a focus on health equity, more transparency around performance data and finding ways to work more closely with private payers.
Fierce Healthcare: Hospitals feel congressional heat over compliance with price transparency rule (3/28) – House lawmakers are exploring taking a larger role in getting hospitals to comply with a landmark price transparency rule. Several members of the House Energy and Commerce Committee’s health subcommittee asked experts Tuesday how to get more hospitals in line with the rule that requires them to share pricing data on certain shoppable services. Lawmakers asked several witnesses at the hearing on ways to boost hospital compliance, a signal that Congress could step in if facilities continue to drag their feet.
Medical Economics: Prescription for better U.S. health care spending: Four areas to consider (3/28) – Streamlining administration, price controls and competition, spending growth targets, and value-based care will help rein in the wild growth of medical spending in the United States. Those measures were part of “A Road Map For Action: Recommendations Of The Health Affairs Council On Health Care Spending And Value, a report published earlier this year. The nonpartisan group of experts aimed to moderate the growth of health care spending, while maximizing its value.
Illinois Attorney General: Attorney General Raoul Announces House Passage of Legislation Increasing Oversight of Health Care Market Consolidation (3/27) – Attorney General Kwame Raoul announced the Illinois House of Representatives on Friday passed his legislation to increase oversight of health care transactions, namely mergers and acquisitions that include health care facilities and large provider organizations, which can lead to higher prices for health care services while quality of care worsens or remains stagnant. State-level review is vital, as many mergers are not scrutinized at the federal level due to a failure to receive timely notice of the transaction or because the merger is too small for federal action.
Kaiser Health News: Banning Noncompete Contracts for Medical Staff Riles Hospitals (3/27) – Eliminating noncompete contracts would allow doctors to practice wherever their services are needed, which would improve patients’ access to care. They say it would free them to speak out about unsafe conditions for patients, since they wouldn’t have to worry about getting fired and not being able to continue working in their community. Health care industry groups hope to block any change with the argument that the FTC lacks statutory authority to regulate nonprofit, or tax-exempt, hospitals, which account for nearly 60 percent of all U.S. community hospitals. In the proposed rule, the FTC acknowledged that entities not conducting business for profit may not be subject to the rule. As of last year, nearly three-quarters of all U.S. physicians were employed by hospital systems or other companies, with many working under noncompete agreements. A 2018 survey found that nearly half of primary care physicians in California, Illinois, Georgia, Pennsylvania, and Texas were bound by noncompetes.
RevCyle Intelligence: Price Transparency Data Reveals Most Expensive Brain MRI Locations (3/27) – Nonprofit and government hospitals tend to be considered the cheaper option for health care, especially compared to for-profit hospitals. However, the study's researchers say that notion is false and their findings underscore the idea that commercially negotiated prices are more tied to hospital market power than ownership status. The study indicates that more competition is needed to bring down health care prices. Research suggests that the recent trend toward provider consolidation has increased costs for consumers with little to no quality improvements. Industry experts have called on federal and state governments to promote competition within health care by reducing administrative burden, requiring price transparency, and reforming Medicare reimbursement policies, such as site-neutral payments.
Becker's Payer Issues: Price transparency means the end of payer-provider 'information asymmetry,' Trilliant CEO says (3/27) – Value-based care isn't yet scaling, but price transparency could bring about widespread value-based competition, Trilliant Health CEO Hal Andrews says. The health care analytics company launched a price transparency analytics tool March 27, matching information from its provider directory to payer price transparency data. The data allows providers and payers to see what other providers are getting paid for the same services. Comparing negotiated rates and quality outcomes across providers in a market could bring about a shift from value-based care to value-based competition between providers, Mr. Andrews said. "Value-based care is something that we've talked about in the country for a long time, but it has never worked at scale anywhere." Value-based care is a "point solution," but widespread competition on quality has the potential to go further to solve cost challenges.
Health Affairs: Accounting For Social Risks In Medicare And Medicaid Payments (3/27) – CMS is supporting payment models adjusted for social risk using small-area deprivation indices combined with patient-level characteristics. The workshop series was an important multiyear effort among stakeholders to promote broader application of such policies with the specific aims of helping Medicare and Medicaid move beyond demonstrations or waivers to programmatic design. Key stakeholders and experts assembled from federal agencies, health systems, payers, patient groups, and academia. They reviewed evidence and arrived at a consensus that clinicians caring for disadvantaged populations require increased funding to address social needs; that payment adjustments should be sufficient to address social needs; that accountability for funding reaching practices and serving patients is needed but without increased clinician burden; and that policy targets should include improved health outcomes and equity, not just overall savings.
Commonwealth Fund : How Congress Can Strengthen Primary Care Through Medicare Payment Reform (3/27) – Part of what accounts for the underinvestment in primary care is low reimbursement for primary care services. The Medicare process for updating payment rates is flawed and outdated, relying heavily on recommendations from a specialist-dominated committee that consistently undervalues the time and resources primary care clinicians need to evaluate and manage their patients. Primary care’s financial unsustainability is further constrained by its reliance on fee-for-service (FFS) payment, a retrospective, piecemeal approach that leaves clinicians maximizing volume and rushing visits. It also discourages innovation, team-based care, and care coordination. These features are associated with better quality and greater patient satisfaction.
American Medical Association: Expert tips help doctors navigate private practice challenges (3/27) – Thriving as a physician in private practice has arguably never been more challenging. At the same time, amid the increasing corporate consolidation of U.S. medicine, the autonomy afforded by private practice has lasting and powerful appeal to many physicians—whether they are just finishing residency or already well into their careers. It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid. A series of 10 episodes —“Private Practice: Attending to Business”— share information and resources to help physicians navigate medical practice business operations and efficiency solutions to create and support a thriving business.
Miami Herald: ‘I don’t want to give up.’ As hospitals get bigger, an independent doctor feels the pinch (3/26) – Before the coronavirus pandemic, Dr. Andrew Bush treated as many as 1,000 patients every month in his orthopedics practice. Now he worries about going bankrupt. The surgeon is among a dwindling number of independent physicians in the United States, where doctors are selling their practices to behemoth hospital systems or leaving the profession altogether. Bush said patient visits have recovered only to half of the pre-pandemic levels because residents are grappling with high inflation and can’t afford to go to the doctor. According to a nationwide survey conducted by the Physicians Foundation in 2020, an estimated eight percent of physicians closed their practices in the early months of the pandemic, and an additional four percent planned to do so.
Fierce Healthcare: Providers want CMS to create new payment methods to boost primary care (3/26) – A collection of nearly 30 provider groups wants the Biden administration to combine FFS and prospective payments to primary care doctors to bolster the workforce. The groups wrote a letter
to officials with the CMS on the need for such a hybrid payment model. The missive comes as CMS has tried in recent months to get more rural and primary care providers invested in value-based care, including offering upfront investments to new entrants in models. A hybrid payment system should be applied to the MSSP, a model that seeks to pay providers on a prospective basis. ACOs that are part of the program agree to abide by quality and spending benchmarks and get a share of any savings but must repay Medicare for missing such targets. The letter comes as the primary care workforce has been struggling in recent years due to underinvestment and worker shortages. A recent primary care scorecard found that a chronic lack of support has strained primary care and that spending on such care has declined slightly across all types of insurance from 2010 to 2020.
Medpage: Dear Congress, Here's How to Fix the Clinician Shortage (3/26) – The U.S. faces a predicted shortfall of between 37,800 and 124,000 doctors over the next 10 years. While physician shortages will affect nearly every specialty, primary care, pediatrics, and psychiatry will suffer the most. The shortages will make it even more challenging to provide care to a growing population, particularly in underserved areas. The country's FFS model not only raises costs for consumers, it reinforces the commoditization of physicians. Clinicians want to help and heal. Value-based care programs tie payments for care delivery to the quality of care provided. These reforms reduce paperwork burdens and allow providers to focus more fully on patients. An October 2020 report from Deloitte concluded, "Value-based care is in line with physicians' intrinsic motivation to deliver the best care to their patients, as it drives improvements in quality, outcomes, and patient experience. Refocusing work from productivity to value can bring meaning to physicians' work and reduce burnout."
Healthcare Dive: More physicians want to leave their jobs as pay rates fall, survey finds (3/23) – Physicians are reporting high levels of burnout and sentiments about leaving their jobs since the pandemic began, according to a recent report. Many physicians are now open to accepting lower pay in exchange for more autonomy and work life balance, with some 71 percent of physicians in another 3,000-respondent survey saying they have accepted jobs with lower pay or would be willing to. Primary care specialties were the most recruited and highest in-demand, falling in line with reports projecting a shortage of primary care physicians in the next decade.
Fierce Healthcare: Here are the 20 highest paid specialties in 2022 as average physician pay drops 2.4%: Doximity (3/23) – Average physician pay fell by 2.4 percent from 2021 to 2022, and that decline in physician compensation comes at a time when U.S. health care workers are facing significant challenges, including economic strains, a growing physician shortage issue and high rates of work-related burnout, according to the sixth annual Physician Compensation Report from professional medical network Doximity. In 2023, physicians will also experience a two percent Medicare payment cut after two decades of flat payments. According to the American Medical Association, when adjusted for inflation, Medicare physician payment declined 22 percent from 2001 to 2021.
|