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.
Join the Partnership to Empower Physician-Led Care (PEPC) and our panel of experts to discuss the impact of provider consolidation on the health care system, as well as actions policymakers can take to promote competition across providers.
Department of Health and Human Services (HHS): (9/17) – HHS announced a 30-day extension for consumers to review and choose health plans through Open Enrollment on HealthCare.gov. The Centers for Medicare and Medicaid Services (CMS) also announced it is expanding services provided by Federally-facilitated Marketplace (FFM) Navigators. Additionally, CMS will re-launch its “Champions for Coverage” program. The program currently includes more than 1,000 local organizations that are active in providing outreach and education about the Health Insurance Marketplace and how consumers can enroll in coverage through HealthCare.gov, Medicaid, or the Children’s Health Insurance Program (CHIP).
CMS: (9/17) – CMS released a Fact sheet on Marketplace, Navigators and other state options such as Section 1332 waiver policies included in the July final rule on Section 1332 waiver regulations and health insurance markets for 2022 and beyond. Overall, the rule expands access to health insurance coverage through the Marketplaces by lengthening the annual Open Enrollment Period, restoring and expanding Navigator duties, and minimizing burden and confusion for consumers.
White House: (9/16) – President Biden announced his intent to nominate Robert Otto Valdez for Assistant Secretary for Planning and Evaluation (ASPE) with HHS.
CMS: (9/15) – CMS released evaluation and savings reports for California, Illinois, Massachusetts, and Washington, all states that are participating in the Financial Alignment Initiative for Medicare-Medicaid enrollees. The Financial Alignment Initiative is designed to provide individuals dually enrolled for Medicare and Medicaid with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs.
CMS: (9/13) – CMS withdrew the Emergency Triage, Treat and Transport (ET3) medical triage notice of funding opportunity, due to insufficient applications received. CMS determined that the insufficient number of applications received would not allow for a sufficient number of Agreements to adequately determine whether the medical triage line intervention described in the NOFO has the potential to maintain or improve quality of care for beneficiaries and reduce Medicare program spending under the Model.
White House: (9/13) – President Biden announced his intent to nominate Alvaro Bedoya for Commissioner of the Federal Trade Commission.
House Energy and Commerce Committee: (9/20) – Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Cathy McMorris Rodgers (R-WA) sent a letter to Secretary of Health and Human Services Xavier Becerra in support of the 2022 Medicare Outpatient Hospital Prospective Payment Rule’s provisions to increase penalties for hospitals not in compliance with the Hospital Price Transparency Final Rule.
House Energy and Commerce Committee: (9/15) – On September 15, the House Energy and Commerce Committee voted to advance its provisions of the Build Back Better Act. The legislation provides vital resources to expand access to health care for millions of Americans by strengthening the Affordable Care Act, closing the Medicaid coverage gap, expanding Medicare to cover hearing, vision, and dental for seniors, and making long overdue investments in home- and community-based care. However, allowing Medicare to negotiate prescription drug prices did not pass out of committee. The text will now go to the Budget Committee for a vote. Section-by-section
House Ways and Means Committee: (9/15) – The House Ways and Means Committee voted to advance its provisions of the Build Back Better Act. The Ways and Means sections include: Medicare dental, hearing, and vision coverage; skilled nursing facilities; elder justice, among other provisions. While very similar to the House Energy and Commerce Committee provisions, the Ways and Means Committee did pass the drug price negotiation provision out of committee. The text will now go to the Budget Committee for a vote. Section-by-section
mHealth Intelligence: (9/20) – The Medical Group Management Association (MGMA) joined with the American Telemedicine Association, American Medical Association, Alliance for Connected Care, and Health Information and Management Systems Society (HIMSS) to ask CMS to amend the proposed 2022 Physician Fee Schedule to permanently extend emergency measures on telehealth access and coverage that were enacted to deal with the pandemic.
American Academy of Family Physicians (AAFP): (9/16) – In their response to the proposed 2022 Physician Fee Schedule, AAFP called on CMS to use its authority to ensure that foundational primary care services are fairly valued in the 2022 Medicare physician fee schedule and Quality Payment Program proposed rule. AAFP wrote this is necessary to deliver stability to family medicine practices hobbled by the COVID-19 pandemic.
California Medical Association (CMA): (9/14) – CMA recently submitted comments on the proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program (QPP) proposed rule. Physician practices face Medicare cuts on multiple fronts that amount to a combined 9.75 percent cut. While not all of the cuts are under CMS jurisdiction, CMA is urging CMS to stop the 3.75 percent budget neutrality cuts that do fall under the agency’s purview, and to reduce the QPP reporting burdens.
Fierce Healthcare: (9/21) – Kidney care startup Strive Health and Nephrology Associates of Northern Illinois and Northern Indiana (NANI) will jointly pursue and manage global risk payment models. This partnership will benefit people with chronic kidney disease and end-stage kidney disease through a “whole patient” approach that enhances lives and communities across Illinois, Indiana and potentially other states.
Healthcare Dive: (9/21) – HCA Healthcare, one of the biggest hospital operators in the U.S., is acquiring Steward Health Care's entire hospital footprint in Utah to meet rising demand in the state. The deal will add five hospitals to HCA's Mountain Division, which currently includes 11 hospitals in Utah, Idaho and Alaska. For its part, divesting the five Utah facilities will help Steward grow in other geographies and frees up capital for the system to invest more in its accountable care model, which is the largest private physician-led model in the U.S.
JAMA Network: (9/20) – The COVID-19 pandemic disrupted the practice of medicine across the US. In response, many physicians reported practice interruptions, with some expressing intent to retire or close their practice. The authors of this article analyzed Medicare data to assess physician practice interruptions and provide preliminary evidence on whether those interruptions suggest early retirements or exit from medical practice.
Fierce Healthcare: (9/20) – Hospital industry groups are pushing back against a proposal to jack up fines for health systems that don't publish their prices, arguing that facilities are putting all their resources behind combating the COVID-19 pandemic. The groups wrote in comments to the 2022 Hospital Outpatient Prospective Payment System (OPPS) rule strongly opposing a proposal to apply fines for noncompliance with a price transparency requirement on a per-bed basis. The current rule fines hospitals $300 a day.
Modern Healthcare: (9/20) – Rural hospitals that merged with or were acquired into larger health systems are associated with greater reductions in mortality for conditions like heart failure, stroke and pneumonia compared to facilities that remained independent, according to a new study. The annual inpatient mortality rate for acute myocardial infarction decreased from 9.4 percent to five percent among acquired hospitals, researchers at the Agency for Healthcare Research and Quality and IBM Watson Health found. Meanwhile, independent facilities saw inpatient AMI mortality fall from 7.9 percent to 6.3 percent during the period studied.
Fierce Healthcare: (9/17) – The Biden administration is extending Affordable Care Act (ACA) open enrollment by another month and slightly increasing insurer user fees for participating on the exchanges to help fund greater outreach. CMS issued the third part of the 2022 Notice of Benefit and Payment Parameters that lays out standards and regulations for the ACA exchanges for the 2022 coverage year. The rule builds on prior final rules governing ACA exchange insurers and related stakeholders in January and May of this year.
Modern Healthcare: (9/16) – Intermountain Healthcare and SCL Health signed a letter of intent to merge. The combined $11 billion health system would operate 33 hospitals, run 385 clinics and employ 58,000 caregivers across six states. Intermountain CEO Dr. Marc Harrison said their service areas do not overlap, and the deal shouldn't trigger any traditional antitrust concerns around hospital mergers.
Benefits Pro: (9/16) – Government regulation may be needed to counter the price pressure created by hospitals in concentrated markets, according to health care experts. Federal and state agencies are taking a close look at market concentration as part of an ongoing effort to address high and rising hospital prices. Authorities also are challenging practices such as anti-tiering and anti-steering provisions in contracts, which heighten the bargaining leverage of dominant health care systems.
Healthcare Dive: (9/15) – Providers pushed back on CMS' plans to overhaul the Quality Payment Program with a new push toward value-based arrangements. The proposed PFS calls for beginning use of the value pathways program in MIPS for 2023 and having it replace MIPS entirely in 2027. The providers said it's unclear whether MVPs would reduce administrative burden as expected or that it would be equitable across specialties.
Becker's: (9/15) – Value-based care can improve the quality of treatment for orthopedic surgery patients and reduce overall costs, according to findings from New York City-based Hospital for Special Surgery (HSS). The implementation of bundled payment programs at HSS saved CMS nearly $24 million, reduced readmissions and reduced medically unnecessary postoperative treatments.
Fierce Healthcare: (9/15) – Many U.S. hospitals have not been publishing their prices, as required by a new law. Now, a panel of researchers, purchasers and regulators is calling for new measures around increasing compliance and the usability of published pricing data. The panel argues in a new report that the requirements could “strengthen the market power of employers relative to consolidated hospital systems and insurers, enhance regulatory oversight and provide researchers with an abundance of information to inform policy making.”