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: (5/17) – CMS released the second evaluation report of the Accountable Health Communities (AHC) Model. Findings to date indicate that the model did not markedly increase beneficiaries’ connections to community services or health-related social needs (HRSN) resolution, suggesting that navigation alone may not be sufficient to address HRSNs.
Energy and Commerce Committee: (5/24) – The House Energy and Commerce Committee held a markup of 19 bills, including seven bills that advanced from the Health Subcommittee related to competition and transparency. The Committee unanimously passed:
The Providers and Payers COMPETE Act (H.R. 3284), which would require the HHS Secretary to consider consolidation impacts during annual rulemaking and CMMI model evaluations; and
The PATIENT Act of 2023 (H.R. 3561), which would require off-campus hospital outpatient centers to attest to unique identifiers and implement site neutral payments for certain drug administration services, among other provisions.
Rep. Spartz (R-IN): (5/18) – Rep. Spartz (R-IN) sent a letter
to President Biden and Congressional leadership highlighting major debt drivers related to overspending in health care that should be considered in debt ceiling negotiations, including implementing site-neutral payments in Medicare. The letter states that this would save $220 billion over 10 years.
Medical Group Management Association: (5/22) – Medical Group Management Association (MGMA), along with 80 health care organizations, sent a letter to Senate Majority Leader Schumer (D-NJ) and Sens. Menendez (D-NJ), Boozman (R-AR), and Collins (R-ME) expressing support for the the Resident Physician Shortage Reduction Act of 2023 (S. 1302) which would increase the number of Medicare-supported graduate medical education (GME) positions by 2,000 per year for seven years.
Medical Group Management Association: (5/17) – MGMA released a poll which found that 47 percent of medical groups tie quality performance metrics to physician compensation plans. This represents a five-percentage-point increase from 2022. Among medical group leaders with quality metrics tied to physician compensation, the percentage of overall compensation tied to quality performance has hardly taken a step back as the industry has continued its recovery from the COVID-19 pandemic, with 36 percent reporting an increase in the share of compensation tied to performance.
Modern Healthcare: What you need to know about Biden's antitrust enforcement (5/24) – Health care consolidation has occurred at a rapid pace in recent years as more companies conclude they can't flourish on their own. Merger and acquisition partners tout greater efficiency as a means to reduce health care spending, but evidence suggests these deals lead to less competition, higher costs, lower quality and suppressed wages. The Biden administration has taken an aggressive approach to health care deals. Biden signed an executive order in 2021 that directs agencies such as the Federal Trade Commission and the Justice Department to prioritize hospital and insurance consolidation. Antitrust agencies have targeted deals between among health systems and, more recently, paid increased scrutiny to transactions involving digital health providers, tech companies and pharmacy chains.
Axios: Some states encourage hospital mergers while feds cast wary eye (5/24) – As federal policymakers step up oversight of hospital mergers, more states are taking steps to encourage consolidation in the industry — or to have the final say on whether such moves are anti-competitive. The policies are a sign of the power some hospital lobbies continue to wield in statehouses, where they've argued mergers are a way to expand the patient base and keep otherwise unprofitable facilities open. Mergers and acquisitions may not be the best way to solve unprofitable hospitals' challenges, experts say. Research shows that acquisitions can keep rural facilities open, but that facilities usually wind up cutting services that community members rely on. Mergers can also slow wage growth for health care workers.
American Economic Liberties Project: Economic Liberties Applauds Minnesota Legislature Vote to Rein in Health Care Monopolies (5/22) – The Minnesota Senate passed legislation (HF 402) which gives state enforcers new powers to block hospital mergers and creates a new notification system for mergers in health care markets. The bill has passed both chambers of the state legislature and now moves to the governor. “The Minnesota legislature is absolutely correct in focusing on the harms of hospital monopolies and approving new state powers to rein them in,” said Pat Garofalo, Director of State and Local Policy at the American Economic Liberties Project. “HF 402 gives the state attorney general the ability to review and block hospital mergers that will result in worse care or lower wages, creating a public interest standard that will protect Minnesota communities from rampant health care consolidation. We look forward to the governor signing this vital measure into law.”
New York Times: When Corporations Take Over Health Care | Opinion Letters (5/21) – It seems to me that the fact that “multibillion-dollar corporations, particularly giant health insurers,” are gobbling up primary care practices to make more money and increase their control of health care delivery is old news to most American physicians. As the power of the corporations in our health care system increases, the power of our physicians decreases. Back in the day when physicians, and not corporations, ran the whole show, it used to be a beautiful thing to be a primary care physician in America. Having built a vast empire, corporate America is now solidifying it by adding primary care, squelching any remaining autonomy in the medical profession. Profit-seeking organizations should not be given this overwhelming authority to administer health care, precisely because it is a conflict of interest: profit motive over equitable patient care.
Forbes: As Healthcare Organizations Get Bigger, Healthcare Workers Feel Smaller (5/19) – There are two trends hitting health care right now, and they’re not unrelated. One is consolidation; big health care organizations are getting even bigger. The other is burnout. And the sooner we realize the connection between them, the better off the industry will be. Too often, health care professionals who work inside large organizations feel deeply invisible. Inside their workplaces, standardization becomes a burden. When an employee tries to do things differently or to tailor care to an individual patient’s needs, they’re told, “The policy is the policy.” Bigger does not feel better. The are transformed from highly trained professionals into invisible line workers. There is a loss of agency that can be painfully numbing.
STAT: House panel takes first steps toward reining in hospitals with ‘site-neutral’ changes (5/17) – The Energy and Commerce health subcommittee passed a provision that would ensure Medicare pays the same amount to doctors who administer drugs whether they’re given in a hospital or a physician’s practice. It’s a setback for the hospital industry, which has been aggressively fighting that and other efforts to equalize Medicare payments, a set of policy changes known as “site-neutral” rates. Site-neutral policies in Medicare could take more than $150 billion out of the industry over the next decade. The new provision, however, would only save the federal government a little more than $3 billion — a smaller but still sizeable loss for hospitals. Energy and Commerce Committee Republicans had hoped to go further toward those more aggressive policies and Chair Rodgers (R-WA) introduced and then withdrew those bolder proposals during the hearing, seemingly to signal a desire for future discussion. “I reject the premise that the only way to make hospital financials work is to cross-subsidize loss leaders by making hospitals and Medicare overpay for certain services,” McMorris Rodgers said.
Health Affairs: Health Care Impacts Of Resource Navigation For Health-Related Social Needs In The Accountable Health Communities Model (5/17) – Social determinants of health (SDOH) can adversely affect health and therefore lead to poor health care outcomes. When it launched in 2017, the AHC Model was at the forefront of US health policy initiatives seeking to address social determinants of health. The AHC Model, sponsored by CMS, screened Medicare and Medicaid beneficiaries for health-related social needs and offered eligible beneficiaries assistance in connecting with community services. This study used data from the period 2015–2021 to test whether the model had impacts on health care spending and use. Findings show statistically significant reductions in emergency department visits for both Medicaid and fee-for-service (FFS) Medicare beneficiaries. Impacts on other outcomes were not statistically significant. Collectively, findings provide mixed evidence that engaging with beneficiaries who have health-related social needs can affect health care outcomes.
Healthcare Innovation: More Insurers Finding Ways to Pay for Health Equity (5/23) – The CMS Innovation Center’s ACO REACH model is an evolution of the Direct Contracting model and will test how providers can be incentivized to collaborate across multiple treatment plans, spend more time with patients with complex, chronic conditions and ultimately, improve patient health outcomes. Each model participant must design and implement a comprehensive health equity plan that identifies its underserved communities and establishes initiatives to measurably reduce health disparities within their beneficiary populations. ACO REACH also is incorporating a Health Equity Benchmark in which ACOs working with underserved patients, as determined by an “area deprivation index” and Medicaid eligibility, receive an additional $30 per beneficiary per month payment. Kedar Mate, M.D., president and CEO of the nonprofit Institute for Healthcare Improvement (IHI), calls the program’s equity benchmark a good starting point. “I don't know whether that amount alone will be sufficient to attract a great deal of attention, but I do think it's a start. It's exactly what we should be seeing more of and it's likely enough to at least invite the ACO REACH participants to pay attention to inequities in their design and to start to consider disparities and inequities and build solutions into the approach in the model.”