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.
PEPC: (11/9) – PEPC released a statement applauding CMS on the release of the refreshed strategic vision and objectives one-year report. PEPC is pleased to see that CMS is building on the Strategy Refresh by identifying metrics it will use to judge progress against core goals. PEPC continues to believe that CMS must leverage the physician-patient relationship to build trust in accountable care, which independent practices and physicians are essential to, and urges CMS to ensure that its models do not further exacerbate already troubling consolidation trends.
PEPC (11/2): A bipartisan group of 44 members of Congress sent a letter to Congressional leadership requesting an extension of Medicare’s 5 percent Advanced Alternative Payment Model (APM) incentive payments. PEPC worked with other stakeholders to build support for this letter.
RevCycle Intelligence: Bipartisan Letter Requests Extended Value-Based Payment Incentives (11/4) – More than 40 House lawmakers have asked congressional leaders to support value-based payment incentives and extend the 5 percent bonus for Alternative Payment Model (APM) participation. In a bipartisan letter sent to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy, the House members emphasized how the APM incentive payments help providers shift from fee-for-service to value-based care models. ACOs saved Medicare $3.6 billion in 2021, which is significantly higher than the $613 million offered in 2022 APM incentive payments. “It’s clear that MACRA’s investments in value-based care have provided a strong return for the government that can continue providing savings in the future, while encouraging the kind of proactive, coordinated health care delivery that patients want and deserve,” the House members wrote.
CMS (11/7): CMS released of the CMS Innovation Center’s strategy to support person-centered, value-based specialty care. PEPC is pleased to see that CMS is committed to working with stakeholders to ensure models are accessible to a range of providers, including small providers, independent practices, and physicians practicing in rural and/or underserved areas. In particular, the strategy recognizes that different supports may be needed for independent, physician-led model participants compared to hospital-affiliated population-based model participants. We look forward to working with the CMS Innovation Center to implement its strategy.
Aledade: (11/2) – Dr. Jen Brull, Vice President of Clinical Engagement at Aledade, recently hosted a webinar featuring physicians from two Aledade member practices - Dr. David Kuo from Utah Physicians Care Center, and Dr. Charles Catania from PentaHealth - where they discussed the secrets behind their Medicare Shared Savings Program (MSSP) success in performance year 2021. With the help of Aledade, PentaHealth achieved a quality score of 100 percent and complete 90 percent of ED outreach within seven days or less, while Utah Physicians Care Centers had 90 percent blood pressure control among their patient population and 100 percent A1C control.
Health Affairs: The Rise Of Cross-Market Hospital Systems And Their Market Power In The US (11/7) – From 2010 to 2019, 1,500 hospitals were targets of a merger or acquisition, with 55 percent being located in a different commuting zone than the acquiring hospital or system. These mergers and acquisitions increased the share of systems that were cross-market systems—either state, census division, census region, or national systems—from 53 percent to 59 percent. Based on market-share thresholds described in this article, the number of hospital systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven to fifty-seven systems (or 54 percent) from 2009 to 2019. The growing prevalence of cross-market hospital mergers accompanied by empirical evidence that such mergers are associated with price increases demands further investigation by economists, legal scholars, and antitrust enforcers to determine the circumstances in which cross-market mergers can harm competition in health care markets.
Axios: More physicians unionize in the face of burnout, consolidation (11/7) – Burnout and health industry consolidation are driving more doctors and doctors-in-training to unionize to demand better pay, benefits and working conditions. There were more than 67,000 physician union members, or about seven percent of all practicing U.S. doctors, as of 2019, according to the American Medical Association. The numbers have likely increased since then, in response to hospital consolidation and more physicians working as employees of a health system or other provider.
Fierce Healthcare: CMMI aims to bolster primary, specialty care coordination via new payment models (11/7) – The Biden administration wants primary care and specialty providers to work closer together, including via new population-based payment models to bolster referrals to specialists. “We can’t have accountable care if our episode models were providing incentives for providers to do their own thing and not integrating with primary care,” said CMMI Director Liz Fowler in an exclusive interview with Fierce Healthcare. Several experts have called on CMMI to design any future episode-based payment models to align “incentives between specialists and population-based model initiatives,” the report said. CMMI is also hoping to roll out next year or in 2024 a new advanced primary care model that would ensure equitable access by recruiting safety net and Medicaid providers.
Nola.com: As health care systems expand, independent primary care doctors are a dying breed (11/6) – Growing overhead costs, increasing administrative requirements, the rising use of urgent care outlets and the pull of quickly-expanding hospital systems have combined to shrink the number of these practices. At the same time, some doctors chafe at how many patients they're asked to treat at large systems, and how quickly. And the ones who have chosen to remain independent say that the tradeoffs chip away at patient trust. Dr. David Myers, a solo independent practitioner in Metairie, thinks independent doctors have more incentives to keep patients out of the hospital than those that work within a larger network. Yager points to the initial hesitancy and then the outright rejection of the COVID-19 vaccine as an example of why a personal connection to a family doctor is important. “People don’t trust health care,” said Yager. “They trust the people that take care of them.”
BMC Health Services Research: The impact of price transparency and competition on hospital costs: A Research on All-Payer Claims Databases (11/5) – This study observed limited evidence of the impact of all-payer claims databases (APCDs) and market competition. Our findings suggest that states need to make multifaceted efforts to contain hospital costs, not solely depending on the rollout of cost information or market competition. The existing literature also demonstrates some potentially harmful impacts of increased concentration in the healthcare market, such as inefficient use of resources, unilateral market power, and deterrence of innovation. The introduction of a price transparency tool may require additional policy actions that take market competition into consideration.
Health Affairs: Advancing Equity Through Value-Based Payment: Implementation And Evaluation To Support Design Goals (11/4) – Building off of our previous work, this piece discusses major equity-focused design, implementation, and evaluations considerations for value-based payment (VBP) models. We discuss ways to ensure VBP models serve people from diverse communities, provide new tools for patient communications and engagement in model design and implementation, and provide tools for cultural competency and humility in engaging people in VBP. We also discuss cross-sector data exchange and referral platforms, incentives for meeting social needs, and equity-focused technical assistance programs. Finally, we outline how future evaluations might capture evidence on what is improving equity. The approaches and future directions summarized in this article will assist CMS, states, and commercial payers to maximize the potential of VBP health care transformation to advance health equity.
RevCycle Intelligence: Health care Orgs Urge Congress to Improve Value-Based Care Participation (11/3) – Health care groups have called on Congress to extend incentive payments, revise threshold requirements, and expand regulatory waivers to address concerns about MACRA and boost participation in value-based care models. Some of the main concerns from the groups centered around the various thresholds included in MIPS and APMs. Another central request from the health care groups was for Congress to extend the 5 percent APM incentive payment. The health care groups urged Congress to pass various legislation to help improve value-based care participation. NAACOS asked Congress to direct CMS to establish a common set of waivers for APMs, allowing all APMs to access waivers instead of limiting them to certain models.
Politico: The health policy Rand Paul and Elizabeth Warren agree on (11/3) – In a bipartisan letter
sent Wednesday, 46 senators — from Sen. Rand Paul (R-Ky.) to Sen. Elizabeth Warren (D-Mass.) — asked leadership to address looming Medicare payment cuts to providers before the new year, when they would take effect. The letter comes a day after CMS released its final rule confirming the cuts, which are required by law. The group of senators is looking for sustainable changes — alongside a quick fix — to the current payment system. “Going forward, we support bipartisan, long-term payment reforms to Medicare in a fiscally responsible manner,” the senators wrote. The suggestion to change the system comes after a September request from House members for information on the same topic in the hopes of changing the current system.
NY Times: Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says (11/3) – Companies selling private Medicare plans to older adults have posed as the Internal Revenue Service and other government agencies, misled customers about the size of their networks and preyed on vulnerable people with dementia and cognitive impairment, according to a new investigation of deceptive marketing practices in the industry released Thursday by Democrats on the Senate Finance Committee. Many individuals say they were enrolled in plans without realizing it. The report catalogs complaints from 14 states, and a multitude of marketing materials generated by the insurers and the companies they hire to help sell the private plans. The committee says people both in traditional Medicare and those already in a private plan have been inappropriately switched.
Healthcare Innovation: CMS Officials’ Smart, Principled Calculations Around the MSSP Are Paying Off (11/2) – What’s significant here is not only that Biden administration health care policy officials are shifting the emphasis in the MSSP program from what that emphasis had been under the Trump administration; they are doing it in a way that is combining something unprecedented—a focus on health equity as a principle driving all the alternative payment models being explored and expanded under CMS—with a new attitude towards providers, one intended to draw them in rather than to potentially make them revolt. In other words, everyone coming together under the banner of, and through the lens of, health equity, will be an important factor in making all of this work going forward, both conceptually and practically. CMS leaders seem to have found a winning strategy in how to work effectively with providers to move the needle forward in any incredibly important sector of health care activity.