News Clips
Health Affairs: Policy Design Tools For Achieving Equity Through Value-Based Payment, Part 1 (6/7) – Improving health equity in the US will require changing health care payment. But despite the success of value-based payments in resetting expectations away from volume-based reimbursement toward quality and cost efficiency, these arrangements, historically, have not been designed to combat longstanding health inequities. This two-part article reviews seven payment design considerations: (1) organizational participation, (2) payment rules, and (3) risk adjustment in part one; (4) performance measurement, (5) spending targets, (6) performance-based incentives, and (7) care delivery redesign in part two. For each design consideration, related equity challenges and goals are highlighted, as well as a set of policy design tools that are aimed at achieving equity through value-based payment.
Paragon Institute: Reducing Overpayments in Medicare through Site-Neutral Reforms (6/7) – Medicare overpays for certain services provided in hospitals that can be safely and effectively performed in a physician’s office—simply because of the site of care rather than the underlying cost. This distorts the overall health care market, including by incentivizing hospital acquisition of physician practices. Reimbursing based on clinical complexity or patient health status can reduce overspending by government and the private sector while reducing out-of-pocket costs for patients. Congress should enact site-neutral payment policies in Medicare by consolidating existing payments systems, adjusting rates, or removing other restrictions in ambulatory and post-acute care settings.
Kaiser Health News: Burnout Threatens Primary Care Workforce and Doctors’ Mental Health (6/7) – Burnout in the health care industry is a widespread problem that long predates the Covid-19 pandemic, though the chaos introduced by the coronavirus’s spread made things worse. Health systems across the country are trying to boost morale and keep clinicians from quitting or retiring early, but the stakes are higher than workforce shortages. Rates of physician suicide, partly fueled by burnout, have been a concern for decades. And while burnout occurs across medical specialties, some studies have shown that primary care doctors, such as pediatricians and family physicians, may run a higher risk. Though the pipeline of physicians entering the profession is strong, the ranks of doctors in the U.S. aren’t growing fast enough to meet future demand. Burnout exacerbates workforce shortages and, if it continues, may limit the ability of some patients to access even basic care.
Kasier Health News: As Fewer MDs Practice Rural Primary Care, a Different Type of Doctor Helps Take Up the Slack (6/6) – Osteopathic physicians, commonly known as DOs, are still a minority among U.S. physicians, but their ranks are surging. From 1990 to 2022, their numbers more than quadrupled, from fewer than 25,000 to over 110,000, according to the Federation of State Medical Boards. In that same period, the number of MDs rose 91 percent, from about 490,000 to 934,000. Over half of DOs work in primary care. By contrast, more than two-thirds of MDs work in other medical specialties. Michael Dill, director of workforce studies at the Association of American Medical Colleges, said it makes sense that osteopathic school graduates are more likely to go into family practice, internal medicine, or pediatrics. “The very nature of osteopathic training emphasizes primary care.”
Wall Street Journal: Burned Out, Doctors Turn to Temp Work (6/6) – Doctors once turned to part-time work mostly as a transition into retirement. Overloaded and burned out, many in their working prime are now building entire careers as temporary physicians-for-hire. About 50,000 doctors, or seven percent of the U.S. physician workforce not including foreign medical-school graduates, now practice medicine via temporary assignments, according to medical-staffing company CHG Healthcare. That is a nearly 90 percent increase from 2015. Many doctors say longer hours and bigger patient loads—especially during the pandemic—have pushed them to shift out of more traditional medical careers. In a 2023 survey of more than 9,100 physicians, a majority described themselves as burned out, up from 42 percent in 2018. Nearly a quarter of those doctors said they had quit jobs or sold a practice as a result, according to Medscape, which conducted the study.
Health Affairs: Improving Quality And Equity Through Neighborhood-Level Measures Of Social Need (6/2) – There is continued interest in using neighborhood-level measures of social need to understand health care use and improve health outcomes. A future direction for policy work would be to increase efforts to test and evaluate the role of neighborhood-level measures in payment and delivery reforms meant to promote high-quality, equitable care. Such efforts are already underway, with measures such as the Area Deprivation Index (ADI) being used to adjust payment for social need in programs such as in advanced payments in the MSSP, the ACO REACH model, and the Maryland Primary Care Program. While these are encouraging developments, rigorous evaluation is needed to understand the impact of these nascent efforts and guide future policy. One reason is to guide appropriate use and curb overenthusiasm about these measures. For instance, prior work on Medicare populations has highlighted potential limitations of using ADI in risk adjustment, suggesting that it could entrench inequities by lowering payments for historically disadvantaged groups. New programs should be paired with rigorous evaluation to guard against or anticipate unintended consequences of using area-level measures in such reforms.
Politico: Doctors and hospitals ready to get riskier in Medicare, if CMS will let them (5/31) – Physicians and hospitals across the country say they are eager to work with the Biden administration on new ways to save Medicare money but are having trouble getting the ear of federal regulators. The Biden administration tried to jumpstart the effort in 2021. However, payment models have been sunset by CMMI and not replaced with many new options to take their place. This has left only one model where physicians and hospitals were fully on the hook: ACO REACH which kicked off earlier this year and is due to end after 2026, and the program is not accepting new entrants. That’s not nearly enough to have the program meet its goals, Sean Cavanaugh, chief policy officer for Aledade, said in an interview with POLITICO. Cavanaugh added there is a “huge appetite from that community to not have to switch into ACO REACH to get some of those [full financial risk] features.” CMMI, however, is making an effort to cut down the number of models it releases in response to criticism that the initial influx of payment models has led to overlap.
Avalere: Assessing the MA Risk-Adjustment Model’s Accuracy Among Subpopulations (5/26) – Avalere’s research indicates that the CMS-Hierarchical Condition Category (HCC) risk-adjustment model may incorrectly predict costs for certain subpopulations, which might perpetuate disparities by overpaying for some low-cost populations and underpaying for some high-cost groups of beneficiaries. This study illustrates that, as beneficiaries have more diagnosed conditions, overprediction increases for those who are non-Hispanic White and underprediction emerges for those who are Black and those who are Hispanic. Further study may be warranted to better understand why trends in predictive accuracy differ across racial groups as the number as HCC counts go up, and whether the addition of the Cures Act may impact the accuracy of the model for specific subpopulations.
Health Affairs: Using Advanced Payments In Population-Based Models To Address Equity (5/25) – Population-based payment models may not be designed to promote health equity without explicit intention—recognition that has spurred the emergence of new models focused specifically on reducing disparities in care. One promising design strategy would be to provide participating organizations with upfront payments that are earmarked explicitly for work that can address inequities. Historically, only a limited number of participants in small demonstrations have been able to access advanced payments—much less those provided specifically to address patient needs in ways that reduce disparities. This article describes features of forthcoming Advanced Investment Payments and future areas of work. Equity-oriented upfront payments are an encouraging development in population-based models—one worth careful consideration from policymakers, payers, and health care delivery organizations seeking to drive accountable care for population health.
Axios: House panel advances transparency and PBM bills (5/25) – The House Energy and Commerce Committee advanced a series of health care measures to promote price transparency and overhaul regulation of pharmacy benefit managers (PBMs) in a mostly bipartisan markup. Even the more modest site-neutral policies that were considered, like equalizing payment for physician-administered drugs, drew concerns from Reps. Tonko (D-NY) and Clarke (D-NY), who warned of the effects on hospitals. That highlights the even tougher lift facing the bigger site-neutral payment policies that were left out for now and address the way hospitals charge more for the same services private doctors deliver in their offices.
|