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.
Department of Treasury: (8/31) – The U.S. Department of the Treasury along with the U.S. Department of Health and Human Services, U.S. Department of Labor, Centers for Medicare and Medicaid Services, and Social Security Administration released the annual Social Security and Medicare Trustees Reports. The report found that the Hospital Insurance (HI) Trust Fund, or Medicare Part A, which helps pay for services such as inpatient hospital care, will be able to pay scheduled benefits until 2026, the same year as reported last year. The Trustees conclude that the financial projections in this report indicate a need for substantial changes to address Medicare’s financial challenges. Fact Sheet
Centers for Medicare and Medicaid Services (CMS): (8/30) – CMS announced Dr. Ellen Montz as Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight (CCIIO). At CCIIO, which manages HealthCare.gov and the federal insurance Marketplace, Dr. Montz will continue the charge for affordable, accessible health coverage.
CMS: (8/30) – CMS is offering additional resources around the Alternative Payment Model (APM) Performance Pathway, or the APP— a new reporting and scoring pathway for Merit-based Incentive Payment System (MIPS) eligible clinicians who participate in MIPS APMs.
CMS: (8/25) – CMS announced that Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (Shared Savings Program) in 2020 earned performance payments (shared savings) totaling nearly $2.3 billion while saving Medicare approximately $1.9 billion, marking the fourth consecutive year of net savings for Medicare.
Senate Finance Committee: (8/26) – Senate Finance Committee Ranking Member Crapo (R-ID) sent a letter to U.S Government Accountability Office (GAO) Comptroller General Dodaro urging GAO to continue monitoring and calling for improvements in delivery of trustees reports on the financial status of Medicare and Social Security trust funds to Congress and the American people.
Health Leaders Media: (8/30) – Physicians in California may face disciplinary action for helping patients obtain inappropriate medical waivers from wearing masks. The Medical Board of California announced on August 18 that “a physician who grants a mask or other exemption without conducting an appropriate prior exam and without a finding of a legitimate medical reason supporting such an exemption within the standard of care may be subjecting their license to disciplinary action.” The California Medical Association released a statement supporting the Medical Board of California’s decision.
Radiology Business: (8/27) – Physician practices are pushing the federal government to extend the deadline for Provider Relief Funds as they grapple with “laborious” reporting requirements and a COVID-19 resurgence. The Medical Group Management Association urged the Department of Health and Human Services to delay the deadline until at least March 31, 2023, regardless of when funds were received.
American Academy of Family Physicians (AAFP): (8/26) – AAFP collaborated with several primary care organizations, to develop a new paradigm for the health care system based on the Shared Principles of Primary Care. The new paradigm calls for a pivot in how primary care is financed from a cost-based model to investing in primary care as a public good. This new financial paradigm translates to increased payments to address the social drivers of health and disease prevention, care coordination, and, most importantly, the relationship between the patient and physician.
Modern Healthcare: (8/25) – In this article, Dr. Margot L. Savoy of the AAFP writes that where you live shouldn't dictate the care you receive. A major cause of this trend is a critical shortage of primary-care physicians. As it stands, the country will need up to 48,000 more primary-care doctors in the next decade. Meeting this urgent need means clearing major regulatory and legislative roadblocks to expand the physician workforce.
Modern Healthcare: (8/31) – The article’s authors argue that value based payment programs would be more successful if CMS engaged beneficiaries more in their own medical care. When CMS's Center for Medicare and Medicaid Innovation first started its work on value-based care, top officials asked the agency to do so in the background, so that Medicare enrollees wouldn't notice any changes to their experiences with the healthcare system. Since then, the agency has learned that beneficiaries need a more prominent role in care management and treatment if value-based care is to improve health outcomes and lower costs.
Patient Engagement IT: (8/27) – The reasons patient-centered care is important in alternative payment models (APM) are twofold. Foremost, patient-centered care and especially shared decision-making can in some cases reduce the use of redundant testing or high-acuity care. Secondly, patient-centered care can generate a better patient experience, improving clinical quality measures and yielding success in an APM, according to the National Academies of Medicine.
Modern Healthcare: (8/27) – Hackensack Meridian Health and Englewood Health appealed the delay of their proposed deal amid opposition from antitrust authorities. The Federal Trade Commission sued to block the 16-hospital Hackensack Meridian Health system's acquisition of the neighboring New Jersey hospital on the grounds that the transaction would likely increase prices and reduce quality. A federal court in New Jersey granted the FTC's request for a preliminary injunction in early August.
Modern Healthcare: (8/27) – The U.S. Department of Health and Human Services has enlisted several firms to audit billions of dollars sent to healthcare providers during the pandemic. Those audits will start soon for thousands of providers who received at least $750,000 in federal financial assistance last year, including from the Provider Relief Fund.
Health Affairs: (8/27) – While a strong foundation of value-based primary care accountability is essential, sustained success in value transformation cannot be expected without similarly aligning specialists’ incentives to reward affordable, high-quality, appropriate, patient-centered care. The roughly 90 percent of commercial health care spending controlled by specialists remains almost entirely entrenched in volume-based, fee-for-service reimbursement models.
AHIP: (8/26) – In a new blog, AHIP writes that one of the main drivers of health care costs is increasing consolidation among hospitals and hospital systems. AHIP said health insurance providers support more government challenges of anticompetitive hospital mergers, increased enforcement by those agencies of the ways that hospital systems abuse their market power, and other remedies to ensure increased competition and lower health care prices for every American.
Fierce Healthcare: (8/26) – Blue Cross and Blue Shield of North Carolina's value-based care program, Blue Premier, saved $197 million last year, new data from the insurer show. Even amid the pandemic, the insurer's program grew, both adding new provider participants and making additional gains in quality and cost improvements.
Health Affairs: (8/26) – In this blog post, the authors recommend combining the Appropriate Use Criteria (AUC) program with existing CMS quality programs. The authors argue this change would be in alignment with CMS’s desire to both harmonize programs and metrics that promote value-based payment and streamline provider obligations.
Renal and Urology News: (8/26) – The continuing COVID-19 pandemic is hastening the retirement of many health care providers. The United States now faces acute shortages of physicians, nurses, and medical assistants, putting medical practices in an unprecedented situation.New data published by the Association of American Medical Colleges (AAMC) revealed there could be an estimated shortage of 54,100 to 139,000 physicians in both primary and specialty care by 2033.
Modern Healthcare: (8/26) – More hospitals are experimenting with outcome guarantees to attract cost-conscious employers. Geisinger has incrementally expanded its 90-day warranty on knee and hip replacements to two-year or lifetime guarantees on knee, hip and shoulder surgeries that cover avoidable complications. Virginia Mason Hospital in Seattle and Hoag Orthopedic Institute in Irvine, California, have surgical warranties for privately insured patients in bundled payment contracts.
Fierce Healthcare: (8/25) – Accountable care organizations saved Medicare $4.1 billion in 2020 and nearly $2 billion after taking out shared savings, according to new federal data. The data, announced Wednesday by the National Association for Accountable Care Organizations (NAACOS), are an improvement over the $2.6 billion in shared savings they generated in 2019 and $1.9 billion after taking out the shared savings.
Managed Healthcare Executive: (8/25) –The transition from treating patients at a provider’s site to delivering care in the home and community requires two things: an ability to incorporate social determinants of health (SDOH) into the care coordination process and the inclusion of value-based care (VBC) and community-based organizations (CBOs) as compensated care delivery partners in VBC networks.
JD Supra: (8/24) – Following a record-breaking first quarter, merger and acquisition (M&A) activity within the healthcare industry kept pace during the second quarter of 2021, showing no signs of slowing. Although the volume of deal activity declined slightly from the first quarter, the value of deals increased to $127.3 billion, a 40 percent increase over Q1, in large part due to significant activity and larger transactions within the digital health space.