Welcome to The Partnership to Empower Physician-Led Care weekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians.
CMS: (10/5) – CMS released a Request for Information (RFI) on establishing a National Directory of Healthcare Providers & Services (NDH) that could serve as a “centralized data hub” for healthcare provider, facility, and entity directory information nationwide. The RFI is seeking input on the current state of healthcare provider directories and steps that it could or should take to create an NHD. CMS believes linking this information may be valuable for providers and payers participating in value-based payment models. Comments are due within 60 days of publication, which is projected for October 7.
CMS: (9/29) – CMS announced the Calendar Year (CY) 2023 participants in the Medicare Advantage Value-Based Insurance Design (VBID) Model. For CY 2023, the VBID Model has 52 participating Medicare Advantage organizations and the estimated number of Medicare enrollees covered by participating Medicare Advantage plans will increase by more than 24 percent compared to 2022.
CMS: (9/29) – CMS announced the projected average premium for 2023 Medicare Advantage plans is $18 per month, a decline of nearly 8 percent from 2022, and the average basic monthly premium for standard Part D coverage is projected to be $31.50, compared to $32.08 in 2022. CMS also noted new policies related to cost sharing that should increase payments from Medicare Advantage plans to providers serving dually eligible individuals who incur high costs.
Congressional Budget Office: (9/29) – The Congressional Budget Office (CBO) released a report identifying policy approaches that federal lawmakers could adopt to reduce the prices that commercial insurers pay for hospitals’ and physicians’ services, thereby lowering health insurance premiums and the cost of federal subsidies. CBO identified three broad policy approaches available to the Congress: promoting competition among providers, which would aim to reduce prices by targeting providers’ market power; promoting price transparency, which would aim to reduce prices by targeting consumers’ and employers’ price sensitivity; and capping the level or growth rate of prices, which would aim to reduce prices by regulating them.
House Budget Committee: (9/30) – Rep. Smith (R-MO), Ranking Member of the House Budget Committee, released a press release on the CBO report. Rep. Smith stated that, “Today’s CBO report confirms that choice, competition, and transparency – key pillars of Republicans’ Commitment to America – are drivers behind lowering health care costs for patients.”
The policies outlined in the CBO report align closely with the GOP Healthy Futures Task Force recommendations PEPC advocated for in a letter sent to Reps. Guthrie (R-KY) and Nunes (R-CA) last month.
Protect our Physicians Act : (9/29) – Sens. Daines (R-MT) and Stabenow (D-MI) introduced the Protect our Physicians Act (S. 5062), which would increase access to mental health programs for physicians suffering from burnout, among other changes.
Medicare Advantage Consumer Protection and Transparency Act: (9/28) – Rep. Porter (D-CA) and nine cosponsors introduced the Medicare Advantage Consumer Protection and Transparency Act (H.R. 9019), which would require Medicare Advantage plans to submit more information on supplemental benefits, encounter data, coverage denials, and prior authorizations. The bill would also require MA plans to submit plan-level data for quality measurement reporting and additional provider network information. Press Release
American Academy of Family Physicians: (10/4) – American Academy of Family Physicians (AAFP) Vice President of Medical Education Karen Mitchell, M.D., discussed how the Accreditation Council for Graduate Medical Education's new program requirements for family medicine will affect residents, programs and their communities. Mitchell notes that this training will prepare students for future practice models, including team-based care and value-based payment systems.
California Medical Association: (10/3) – California Medical Association (CMA) announced that Blue Shield of California is launching a new value-based, shared savings payment model for specialty care physician practices. The program aims to transform how specialty care services are delivered by shifting away from traditional fee-for-service (FFS) to value-based care in an “episode of care” arrangement, focused on providing coordinated, collaborative care across the health care continuum to help ensure patients receive the highest quality care while managing costs.
Aledade: (10/3) – In recognition of National Primary Care Week, Aledade highlighted a white paper examining how the health care workforce shortage is impacting our communities and what stakeholders can do to ensure the future of independent primary care including promoting awareness of the primary care workforce’s critical service, providing short-term financial assistance while advocating for the increase of primary care spend overall, and increasing opportunities for diversity, equity and inclusion in the primary care workforce.
CMA, Aledade: (9/29) – CMA announced that it is hosting a webinar
on November 1 to educate physicians about the California Advanced Primary Care Initiative. California Quality Collaborative (CQC), an arm of the Purchaser Business Group on Health, and the Integrated Healthcare Association (IHA) has convened a coalition of six large commercial health care payors (Aetna, Aledade, Blue Shield of California, Health Net, Oscar and UnitedHealthcare) to enable primary care practices to transform to a high-performing, value-based care model that reduces costs and improves quality and equity. These payers have committed to this coordinated effort through 2025 with the goals of expanded transparency, value-based payment reform, increased investment, and practice transformation support for person-centered care.
AAFP, CMA, MGMA: (9/27) – AAFP, CMA, and Medical Group Management Association (MGMA), along with over 100 provider groups, sent a letter to Reps. Bera (D-CA) and Bucshon (R-IN) thanking them for the introduction of the Supporting Medicare Providers Act of 2022 (H.R. 8800), which would mitigate Medicare payment cuts that are anticipated to take effect on January 1, 2023 by providing a 4.42 percent positive adjustment to the Medicare Physician Fee Schedule conversion factor. The letter warns that the long‐term consequence of failing to avert the cuts is less patient access to care.
Healthcare Exec Intelligence: (10/3) – Crystal Eubanks, senior director of care redesign at the Purchasers Business Group on Health (PBGH), was featured on the Healthcare Strategies podcast to discuss key lessons on value-based care collaboration in advanced primary care efforts. PBGH, a group of payers, providers, and other health care stakeholders that works to advance primary care in the state of California through value-based care collaboration, has worked extensively with providers, offering technical assistance for the transition to value-based care. After about four years, these efforts yielded cost savings of $180 million across 4,500 providers who served around 3 million Californians.
American Medical Association: (10/3) – The Medicare payment model is continually being undercut which is bad for physicians, bad for patients, and bad for our health system. The American Medical Association’s (AMA) Recovery Plan for America’s Physicians includes reshaping the Medicare payment system to ensure financial stability and predictability, safeguarding access to high-quality, value-based care, and addressing the concerning rise in physician burnout. While maintaining a financially viable FFS model, alternatives that invest in practice transformation are also essential. Alternative payment models designed by physicians can remove barriers to the innovation required to address the chronic disease epidemic our nation faces.
RevCycle Intelligence: (10/3) – More than 800 accountable care organizations (ACOs) and health care associations have asked Congress to support value-based care and extend the Advanced Alternative Payment Model (APM) incentive payments. In addition to encouraging providers to enter alternative payment models (APMs), the incentive payments provide resources that can be used to expand value-based services, such as reducing cost-sharing for beneficiaries, hiring care coordinators, and paying for transportation and meal programs. Promoting Advanced APM participation can also help the Medicare program save money, as ACOs have saved Medicare nearly $17 billion in gross savings and $6.3 billion in net savings since 2012. The organizations said providers need greater incentives from Congress to participate in APMs and urged the lawmakers to extend the payment incentives.
Modern Healthcare: (10/1) – This interview with Dhruv Chopra, Chief Executive Officer of Collaborative Imaging, a physician-owned alliance of independent private radiology practices, focused on what is causing independent practices to be acquired and the key tactics they can put in place to remain financially independent and successful. To remain independent, Chopra notes three important components: technology, identifying opportunities to reduce costs and improve revenue collections, and creating sensible partnership models.
Hospice News: (9/30) – The hospice component of the value-based insurance design (VBID) demonstration will include elements designed to promote health equity in 2023, including health equity plans detailing how model participants will address disparities in outcomes, access, or beneficiaries’ care experiences. The hospice carve-in is one component of the larger VBID demonstration and represents the most significant step to date in moving hospice towards value-based payment models.
Medical Economics: (9/30) – In a 2021 survey by the Physicians Foundation, 56 percent of independent physicians and 66 percent of primary care physicians reported frequent burnout symptoms. Although the number of independent practices has consistently decreased, physician burnout has consistently risen. There is a clear link between both autonomy and ownership, and loss of autonomy and burnout. However, while physicians in smaller and independent practices do have more control and autonomy, which can help alleviate burnout, they don’t necessarily have the resources and finances to implement the evidence-based programs, practices, and policies that improve physician well-being. The authors urge the government to examine how policies have led to consolidation of health systems, eliminated independent practices, and added to rising health care costs without clear evidence of improved quality. Additionally, they recommend Medicare lift the moratorium on physician-owned hospitals and support physicians financially by aiming for Medicaid and Medicare parity on a national level.
HIT Consultant: (9/30) – As we emerge from a public health crisis that magnified and exacerbated health disparities, the need to address social determinants of health (SDOH) has reached a pivotal moment. In both social and healthcare, the pressure is mounting to address key drivers of health and amplify value-based care models. Because the FFS system doesn’t financially incentivize the time and resource-intensive approach required to deliver whole-person care, innovators are developing new payment models and new measures of success that support keeping people healthy. Instead of relying on FFS reimbursements, they utilize value-based arrangements to fund their SDOH efforts, such as hiring new types of resources like community health workers and establishing new processes to build trust and fully understand the member’s life.
Health Leaders: (9/29) – MGMA conducted a survey
of physicians which reveals the potential ramifications of the impending 8.5 percent reduction of Medicare rates in 2023. In response to the proposed rule, 58 percent of respondents said they are considering limiting the number of new Medicare patients and 66 percent said they may reduce charity care. Other possible effects from the survey included the reduction of participation in value-based payment contracts. Other medical groups have also released their own comments pushing back on the rule and warning of the consequences for providers and patients.
RevCycle Intelligence: (9/28) – Robert Fields, MD, MHA, EVP and chief population health officer at Mount Sinai Health System, identified four key areas providers should consider to get to value-based transformation: contracting, physician compensation, digital medicine, and care delivery. Fields notes that the key to contracting is “getting into risk-based contracts and driving that performance so you can make the care of those patients sustainable, especially with the growth in Medicare.” Value-based contracts align system goals of better quality at lower costs with physician compensation. This compensation structure decreases physician burnout while keeping the health care organization competitive. Digital medicine is key to value-based care transformation and Fields suggested that health care organizations consider scheduled and on-demand telemedicine, AI-enabled delivery, remote monitoring, consumer-level health data integration, and digital tools for customer acquisition. Lastly, fostering team-based care and providing support for care providers is key to value-based care transformation, especially in the face of a challenging labor market.
Healthcare Finance News: (9/28) – Physicians participating in a Primary Care Collaborative session on September 27, focused on achieving equitable primary care services, noted that the current risk adjustment underestimates the total cost of care of patients who have comorbidities and socially complex issues. One issue discussed was reimbursement, as physicians are getting paid to treat specific diseases, rather than the whole person. The session also raised questions regarding whether the current risk adjustment system improves the quality of care for the patient. Physicians highlighted the need bidirectional effective communication and interoperability, especially to get to value-based models, such as capitation.