News Clips
Healthcare Innovation: Bringing Value-Based Care to Rural and Underserved Communities (1/23) – In a letter to CMS, NAACOS recommends a paradigm where safety-net-minded APMs focus on increasing or maintaining access rather than purely reducing costs. CMS should modify its APMs through the use of waivers specific to safety-net providers or develop new ACO tracks/total cost of care models focused on rural and underserved populations to account for the fundamental differences they encounter. Population-based payment models reward better care management and lower cost of care for patients, so they need appropriate incentives and rewards which are difficult to provide by these payment arrangements for safety-net providers.
Lown Institute: The rising danger of private equity in healthcare (1/23) – Private equity (PE) acquisitions in health care have exploded in the past decade. The number of private equity buyouts of physician practices increased six-fold from 2012-2021. At least 386 hospitals are now owned by private equity firms, comprising 30 percent of for-profit hospitals in the U.S. Private equity buyouts did not come from out of nowhere, so what does this trend tell us about our healthcare system? PE acquisitions are in many ways a symptom of larger issues in healthcare, such as increasing administrative burden, tight margins, and lack of regulation on consolidation. For owners of private physician practices that face a lot of administrative work, deciding to sell to a PE firm to reduce this workload and focus on patient care (not to mention, getting a hefty payout) is a tempting proposal.
Modern Healthcare: Doctors facing Medicare cut seek new payment system (1/22) – Physicians confronted a Medicare reimbursement cut this year, but the American Medical Association and other organizations are also looking ahead to a bigger fight: completely overhauling how the program pays doctors.“ A central piece of any effort should be to ensure that clinicians are provided with ample opportunities and incentives to help facilitate the move toward a value-based health care system,” Ryan McBride said. “Many specialists, like emergency physicians, have simply had no ability or pathway to participate in value-based care models, which only hinders our collective effort to transition to a system that rewards value over volume,” he said. The cost and quality measures central to MIPS, and the financial incentives they create, are meant to drive value-based care but are too indirect about it, said National Quality Forum President and CEO Dana Gelb Safran. “What MIPS does instead is kind of choose-your-own-adventure,” Safran said. The system rewards current performance, not improvement, which doesn’t promote value-based care, she said.
Med City News: What Are the Challenges in Moving Along Value-Based Care in Rural Communities? (1/21) – Value-based care has been cited as a way to reduce health care costs and improve outcomes. However, adoption has been slower in rural communities, with rural providers facing several uphill challenges, according to one health company executive. “Providers I’d say have been a bit more resistant in rural areas to take on risk, to take on value-based care. And it’s understandable. Many of them are struggling to stay afloat, stay viable,” said Amar Kendale, co-founder and president of Homeward Health, during a recent interview at CES 2024. “So they’re really optimizing what they know well, which is fee-for-service, in order to do that. There also aren’t the same kind of market pressures that you have in urban or suburban areas where the health plans can be a bit more assertive in terms of pushing their networks towards value.”
Health Affairs: Value-Based Care Can Transform The Treatment Of Patients With Substance Use Disorder (1/19) – The payment failures can be addressed and solved, but not with ad hoc patches to the current fee-for-service system. Here, we describe how to dramatically improve care for patients with SUD by systematic adoption of four value-based care (VBC) principles. These principles, which are already being applied for other medical conditions, can be successfully introduced and scaled to accomplish large reductions in the US’s annual SUD-related death toll. VBC’s twin goals are to improve outcomes that matter to patients while lowering treatment costs. The VBC agenda requires four necessary and reinforcing steps to achieve breakthrough performance in patient outcomes and cost reduction: (1) Organize care around the medical condition; (2) Measure and improve outcomes that matter to patients; (3) Measure and lower the cost of treating patients for the medical condition; and (4) Use value-based payments to reimburse providers.
Fierce Healthcare: Industry Voices—PINning down better patient care: A closer look at CMS's decision to pay doctors for patient navigation services (1/18) – Perhaps the most important step that CMS must take to ensure PIN succeeds, however, is integrating such services within CMS’ larger goal of enrolling every Medicare and Medicaid beneficiary in accountable care relationships by 2030. Value-based care has long represented what health care should have always been about: better patient care at lower total costs. Under such arrangements, providers are rewarded for achieving quality outcomes that do not exceed specific cost ceilings. To that end, PIN services are tailor-made to improve care quality and health outcomes by helping patients adhere to their treatment plans, address their health-related social needs, and make their appointments. But PIN could also increase care costs unnecessarily if they are applied to patients who don’t need them and won’t benefit from the extra support.
Daily Independent: Hussain: Site-neutral reforms are the key to cutting healthcare costs (1/17) – Would you buy hamburger for the price you pay for filet mignon? Apparently, you would if you were the federal government. The Medicare program reimburses physicians affiliated with hospitals at higher rates — sometimes two to three times higher — than they reimburse independent physicians … for the same service. These services include things like chemotherapy, cardiac imaging and colonoscopies. Since Medicare pays more to hospital-affiliated doctors for the same routine services, all patients end up paying more through higher premiums and out-of-pocket expenses. Why? Because private insurers base their rates on a percentage of what Medicare pays. In other words, when Medicare’s costs increase, everyone’s costs increase. Medicare reimburses hospitals 141 percent more than an independent physician’s office for chemotherapy infusion. In Dallas, Medicare paid a doctor’s office $375 for a heart muscle image but paid a hospital $1,300 for the same thing.
STAT: Congress’ negotiations over doc pay, health centers fell apart ahead of spending extension (1/17) – Negotiations to add extra health care policies to Congress’ stopgap funding bill fell apart late last week, five sources told STAT. The provisions at issue included a bump to physicians’ Medicare pay rates. When lawmakers were negotiating a deal to extend government funding until March, congressional leaders were also considering attaching new health care spending items to the package that hadn’t been included in prior short-term funding bills. Those are the talks that ultimately broke down, said a congressional aide, two lobbyists, and a health care industry source. Lawmakers decided instead to simply extend policies that had already been included in prior bills. The breakdown isn’t final — talks are expected to continue, now that lawmakers are likely to extend government funding deadlines to March. But the tenor of the discussions offers hints about Democrats’ and Republicans’ health priorities heading into those bigger negotiations. The government funding package is likely the only vehicle for new health care policy ahead of the 2024 election.
STAT: The decline and fall of elite multispecialty medical groups (1/17) – Geisinger is only the latest member of an elite group of large regional multispecialty medical groups to lose their independence and join large hospital systems or corporations. Multiple factors contributed to the accelerating die-off of these groups in the past decade. Federal health policy played a decisive, and destructive, role. As their local communities and regions aged, and younger people moved away, these multispecialty groups were more dependent on the Medicare Part B fee schedule, whose payments to clinicians have lagged inflation by 26 percent since 2001. Medicare Part B fees also serve a crucial role as the reference standard for commercial insurance and Medicare Advantage (MA) rate negotiations. So Medicare’s inadequate adjustment for inflation echoed in lagging commercial insurance and MA rate payments.
STAT: Could private equity be the future of private practice? A new lobbying group thinks so (1/16) – Private equity gets a bad rap in health care. But some doctors see that kind of cash and consolidation as the only way for their practices to survive — and now, they’re taking that message to Washington. Lower pay, difficult negotiations with insurance companies, regulatory requirements from both government and commercial payers, expensive and inefficient IT systems, and the challenge of competing against hospital systems have created a “cascade of problems that seem like they are almost insurmountable” for independent practices, said Paul Berggreen, a gastroenterologist at Arizona Digestive Health. Berggreen is joining with other doctors to start a lobbying group for private practices, the brand-new American Independent Medical Practice Association, or AIMPA, to fight against those problems and advocate for private practice physicians.
Axios: Health industry reignites debate over mandatory payment experiments (1/16) – The health care industry is again grappling with how aggressively to push providers into payment arrangements that hold them financially accountable for delivering better and more efficient care after the debate was largely put on hold during the pandemic. A central question surrounding the long-running movement toward value-based care has been how quickly and broadly to require providers to participate in fixed-payment arrangements and other alternative models. Soon after taking office, the Biden administration offered hints about its interest in mandatory payment models, but it's only recently begun taking concrete steps toward testing them out. A new mandatory model is still at least two years away, and the Medicare official overseeing the effort said she's confident the industry is ready. The industry itself, however, still sounds ambivalent about the idea. "We think the health system is ready for this type of model and expecting us to go in that direction," Liz Fowler told Axios.
Healthcare IT News: HHS Secretary names first Chief Competition Officer (1/16) – HHS Secretary Becerra has appointed Stacy Sanders as the agency's first chief competition officer. In that role, she will lead efforts to implement health care-focused elements of the president’s 2021 Executive Order on Promoting Competition in the American Economy. As chief competition officer, Sanders will lead HHS in data-sharing, creating training programs and developing health care competition policy initiatives to address concentration in health care markets, according to the agency's announcement last week. By working with the Federal Trade Commission and Department of Justice on enforcement initiatives in labor, agricultural and health care markets – which includes prescription drugs, hospital consolidation, insurance and tech – according to a White House fact sheet on the executive order.
Washington Post: Private equity firms are gnawing away at U.S. health care | Op-ed by Ashish K. Jha (1/16) – The number of private equity firms in health care has exploded in recent years, spending hundreds of billions of dollars to buy physician practices, hospitals, laboratories and nursing homes. It’s a trend that should have everyone’s attention, from politicians to patients, because it can significantly increase costs, reduce access and even threaten patient safety. There is also evidence that private equity acquisitions are affecting patient care. Is it time to ban private equity in health care? No. Private equity is as much of a symptom of the health care industry’s woes as it is a cause. Instead, we need a three-pronged approach: First, we need more robust enforcement of antitrust rules to make market consolidation and monopoly pricing less attractive. Second, regulators — particularly Medicare — need to provide a lot more oversight over private equity acquisitions and similar purchases of health care practices. Finally, we need real action on patient safety.
|