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.
PEPC: (3/6) PEPC was pleased to provide input on the CY 2024 Medicare Advantage Advance Notice. Our comments focus on how the proposed policies in the Advance Notice will impact independent physicians and practices participating in, or considering participating in, value-based care models in Medicare Advantage, as well as Medicare fee-for-service (FFS):
Value-Based Care in Medicare Advantage: PEPC continues to support for efforts to encourage further value-based payment adoption in MA, including through incorporating a value-based care Star measure and harmonizing existing measures to reduce burden on small and independent practices.
Impact of Proposed MA HCC Model Changes on Value-Based Care: PEPC urges CMS to consider the far-reaching impact of model changes in their analysis when considering finalizing any changes, including applying CMS-Hierarchical Condition Categories (HCC) model updates to value-based care models.
Ensuring Adequate Physician Payment: It is critical to ensure that physician payment is not impacted by proposals in the Advance Notice, as many independent practices continue to operate on very low margins and at a competitive disadvantage compared to other practice settings that receive higher payments for the same services.
CMS: (3/3) CMS released the fourth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) model. Consistent with prior evaluation reports, for Model Year 3, the BPCI Advanced Model reduced total episode payments, post-acute care (PAC) payments, discharges to institutional PAC settings, and skilled nursing facility (SNF) days. While hospital and physician group practices (PGPs) reduced payments for medical clinical episodes by roughly similar amounts, the reduction in payments for surgical clinical episodes for PGPs was more than double the reduction of hospitals.
Senate HELP Committee: (3/2) – Senate HELP Committee Chair Sanders (I-VT) and Ranking Member Cassidy (R-LA) released a request for information (RFI) on the root causes of the current health care workforce shortage and potential ways to address it. The RFI states that the Committee intends to identify bipartisan solutions to remedy our nation’s health care workforce shortages and develop these ideas into legislation. Responses are due by March 20, 2023. PEPC plans to respond to the RFI, highlighting workforce considerations for independent practices.
Primary Care Enhancement Act : (3/2) – Sens. Cassidy (R-LA), Shaheen (D-NH), Scott (R-SC), and Kelly (D-AZ) introduced the Primary Care Enhancement Act (S. 628), which would provide for the treatment of direct primary care service arrangements as medical care, allowing health savings accounts (HSAs) to be used to pay for direct primary care.
American Academy of Family Physicians (AAFP): (3/7) – American Academy of Family Physicians (AAFP) recently urged Congress to take several specific steps toward advancing value-based care and improving Medicare physician payment through a letter to Congressional leadership, co-signed by 11 other medical and health care groups including Medical Group Management Association (MGMA). The letter laid out several recommendations including extending the alternative payment models (APM) incentive payments and restoring the rate to five percent.
Aledade: (3/7) – Aledade released a blog post,"The ABCs of Value-Based Care: What You Need to Know," which highlights the important role of physician participation in accountable care. The post notes that physician-led ACOs consistently and dramatically outperform hospital-led ACOs.
Aledade: (3/7) – Aledade announced it is forming a strategic alliance with CareFirst BlueCross BlueShield (CareFirst), connecting CareFirst member physicians with Aledade’s tools and resources that improve the efficiency and effectiveness of independent primary-care physicians.
Medical Group Management Association (MGMA): (3/2) – MGMA commented on the CY 2024 Medicare Advantage Advance Notice, requesting CMS provide timely information and greater transparency on the estimated effect of the changes to the CMS-HCC model and pause implementation of this proposal until information on the estimated impact on physician groups and their patients is examined.
Aledade: (3/2) – Aledade announced it is forming a 10-year collaboration with Humana to provide value-based primary care for Humana’s Medicare Advantage members from in-network Aledade-enabled physicians. The two companies have been working together since 2019 in a limited number of markets.
Medical Economics: How can we ensure the future of independent practices? (3/7) – As an independent, solo, family doctor my practice’s existence is in jeopardy. “Consolidation has not resulted in lower prices, higher quality, or better care experiences. Hospital ownership of a doctor’s group dramatically increases the probability that patients go to hospitals that employ their doctor, even when those hospitals are lower quality and higher cost,” according to Farzad Mostashari, MD, the CEO of Aledade. But the crucial truth is this: small practices are better for patients. And small practices are better for doctors. Small independent practices offer patients the choice of cost-effective, high-quality, and personalized health care. If the personalized medical care offered by small independent practices is to be preserved, the rules of the game must change.
Fierce Healthcare: Providers join insurers in calls for changes to controversial Medicare Advantage pay rule (3/7) – Health insurers have been livid over a proposed payment rule they say will cut Medicare Advantage (MA) payments in 2024. But the Biden administration is now facing stiff opposition from providers, too, who charge a change to risk adjustment codes could hurt practices. “We are concerned with CMS’ lack of transparency regarding the estimated effects of the revisions,” wrote MGMA
in comments. MGMA also wanted CMS to pause the implementation of the proposed risk adjustment changes without more time to study the impact on those in value-based care models.
STAT: In North Carolina, a small hospital deal poses big antitrust questions (3/6) – Hospital systems are turning to cross-market mergers to satiate their thirst for growth and avoid antitrust heat. But hospitals are also still signing other lower-profile deals, which experts believe inevitably lead to higher insurance premiums and create more medical bill stress for people in those communities. North Carolina in particular has been a hotbed of hospital consolidation and has many markets with oligopolies or outright monopolies. According to one study, this part of the state is already considered to be “highly concentrated” for hospital services by federal antitrust standards, and Novant’s acquisitions would further decrease the competitive thresholds.
Healthcare Innovation: Pioneer Melanie Matthews of PSW Takes the Long View on Risk-Based Contracting (3/6) – In general, the health care system is stressed. From a policy perspective, there continues to be interest in policy direction to continue down the value-based care path, to reward performance based on quality and cost… and engaging in models with predictability and that are economically viable. I think the administration is trying to provide more glidepaths for organizations to get onto the path. And you can’t pass the increased cost onto payers in the same way you can pass costs along to consumers at the gas station or the grocery store. So the financial challenges just erode margins. In theory, you’re able to perform in value-based contracts, even when the FFS providers are struggling; so there’s economic interest in the model.
Modern Healthcare: Opinion: To expand primary care in underserved communities, fix incentives - Dr. Clive Fields, CEO of VillageMD (3/6) – Value-based care focuses on outcomes. It promotes prevention, wellness and the management of chronic conditions. To advance health equity, value-based care programs administered by the CMS compensate providers for achieving better results. By allowing physicians to focus on helping patients avoid unnecessary illness and disease progression, value-based care empowers more of them to practice in under-resourced communities and choose a sustainable alternative to reactive and costly FFS health care. As health care leaders, we must not allow the decades-old challenge of expanding care for these under-resourced communities to remain unresolved. Ensuring the long-term success of ACO REACH and programs like it requires us to continuously engage with policymakers regarding the challenges on the front lines of health care.
Modern Healthcare: How health inequity maps out across America (3/5) – The inequities in the nation’s health care system stem from its fundamental attributes, beginning with financial incentives to provide “sick care” on a FFS basis and disincentives to offer services that promote health. Access to health care also is strongly influenced by patients’ ability to pay. More broadly, a history of oppressive laws and business practices and generations of disinvestment in underserved communities are directly linked to poorer health outcomes and shorter lifespans. Health industry consolidation has reduced access in poorer and remote areas, which providers eschew because there isn’t enough money to be made. That, in turn, intensifies the stress on an overburdened, underfunded safety net. This misalignment of capital encourages patients toward inefficient sites of care such as emergency departments and costlier interventions that occur only after medical conditions worsen.
Fierce Healthcare: Physicians are twice as likely as the general population to attempt suicide, Medscape survey finds (3/3) – Nearly a quarter of physicians reported clinical depression in a new Medscape survey, while nine percent admitted to suicidal thoughts, and one percent shared that they attempted to end their lives. Two-thirds of doctors reported colloquial depression, according to the survey. Twenty-four percent of doctors reported clinical depression. Kane pointed to two areas where systematic healthcare alteration could make a difference when it comes to depression: fear of ramifications and burnout. Physicians are calling for hospitals to slow down the pace of productivity and provide more time for patient interactions so physicians feel less like "they are on a rushed hamster wheel."
Becker's ASC Review: The healthcare trends scaring physicians (3/3) – With the growing trend of consolidating care under hospital systems, health insurance-owned care teams and private equity-backed provider groups, the future of health care continues to change. While the overarching goal of the health care system remains maximizing efficiency and outputs, not every aspect of health care can be managed as a business. Health care isn't and shouldn't be viewed as an "efficient" endeavor, since the human condition isn't always predictable. Declining reimbursements for private practitioners encourages formation of groups and consolidation to help providers sustain their practice models, but I fear consolidation leads to less competition: Certain sectors of health care don't face the challenge of healthy competition. This leaves patients with fewer options for care. With that being said, this poses a great opportunity for new private practice groups to take advantage of being nimble and thriving in the changing health care climate.
Center for Health Care Strategies: Health Affairs Blog | Leveraging Primary Care Population-Based Payments in Medicaid to Advance Health Equity (3/3) – High-quality primary care is a critical tool to advance health equity within Medicaid. To support higher-quality, more equitable primary care, there is growing consensus that payment reform is necessary. Medicaid primary care population-based payment (PBP) models — advanced value-based payment (VBP) approaches that pay provider organizations through upfront, flexible payments tied to quality incentives — offer a key means to improve primary care. In this Health Affairs blog post, authors explore considerations for state policymakers implementing Medicaid primary care PBP models to ensure that provider organizations have the right financial incentives to work toward more equitable care delivery and significantly reduce health disparities.
Harvard Kennedy School: Study finds vertical integration in medicine is leading to higher costs and worse health outcomes (3/2) – A new study by a group of researchers finds that in one representative area of medicine, vertical integration is leading doctors to change the way they approach patient care, with consequent adverse effects on patient health, and is also inflating costs. The problem, they conclude, lies in a system of financial reimbursements that incentivizes the wrong behavior—and addressing that issue may offer a solution. The study found that when independent physicians integrated with a hospital, they changed their care practices and increased their throughput. However, patients of integrated physicians experienced “a significant increase in both major post-colonoscopy complications.
National Law Review: New York Proposes Regulatory Overhaul for HealthCare Transactions with a Focus on Investor-Backed Healthcare Transaction (3/1) – Proposed legislation from the New York State Executive Budget for 2024 includes significant changes to the state’s regulatory approach and authority over health care transactions. New York is following a trend on the state level regarding concern over the consolidation of the health care marketplace and investor-backed practices and how such transactions should be reviewed. Such proposal follows states like California, Oregon, and Washington. The proposal creates a new statutory article to review “material transactions” and has made changes to the certificate of need process for new and existing entities.