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News Clips
RevCycle Intelligence: Value-Based Payments in Medicaid Tied to More Behavioral Health Visits (10/10) – Medicaid value-based payment reform was associated with an increase in behavioral health visits for patients with mental health conditions, a study published in JAMA Health Forum found. Researchers analyzed New York state Medicaid FFS claims and encounter data to determine the association of value-based payment reform with outpatient utilization, mental health emergency department (ED) visits, and hospitalizations for Medicaid beneficiaries with major depression disorder, bipolar disorder, or schizophrenia. Value-based payments were associated with a slight decrease in mental health hospitalizations for patients with depression. Similarly, value-based payments led to a reduction in mental health ED visits for patients with depression, bipolar disorder, and schizophrenia.
Axios: What rural health providers want from Washington (10/10) – The National Rural Health Association (NHRA) sent a letter last week outlining actions Congress can take, ranging from enhanced support for staff retention at the poorest facilities to carveouts from some controversial policies strongly opposed by the broader hospital industry. NRHA called on Congress to:
- Increase payment rates and force Medicare Advantage plans to speed up payments that providers say are taking too long to arrive.
- Help rural providers move away from FFS and into value-based payment programs. The providers say they have been largely overlooked in alternative care models coming out of Medicare's innovation lab.
- Exempt rural providers from future site-neutral hospital payment policies that Congress is considering.
Modern Healthcare: Proposed merger guidelines may limit cross-market hospital deals (10/6) – Cross-market health system mergers, one of the industry's most common but relatively unchecked growth strategies, could be thwarted by recently proposed guidelines. An increasing number of health systems have pursued and completed so-called cross-market mergers of organizations that operate in separate, non-overlapping geographic markets. Merging health systems, even if they are located far apart from one another, can produce anticompetitive effects such as price increases if they’re competing for the same consumer, said Leemore Dafny, an economist at Harvard Business School. The FTC and DOJ proposed merger guidelines in July as federal regulators look to broaden the scope of their oversight to limit consolidation that could hurt competition. One section in the proposal addresses how merging parties could extend their dominant position from one market into a related market by “tying, bundling, conditioning or otherwise linking the sales of two products, excluding rival firms and ultimately substantially lessening competition in the related market.”
Healthcare Dive: Physician burnout rate doubled between 2019 and 2021, study finds (10/6) – The rate of physician burnout in the U.S. more than doubled during the first years of the pandemic, with physicians reporting higher levels of exhaustion and cynicism and lower levels of personal efficacy in 2021 compared to 2019, according to a study published on Friday in JAMA Network Open. Burnout levels varied by demographic, with women physicians, less experienced physicians and primary care physicians reporting higher levels of burnout than male physicians, more tenured clinicians or internal medicine providers. Professional factors can insulate physicians from burnout, the study concluded. Physicians who spent less time on administrative tasks, worked in roles outside of primary care and those who were more highly compensated were less likely to report high levels of burnout.
Austin Chronicle: Opinion: Patients Shouldn’t Be Charged More by Hospital-Owned Practices Than Physician-Owned Practices (10/6) – Patient care is being shifted from physician-owned offices to hospital-owned "outpatient departments." They are in office buildings, not a hospital. It may be the same office the patient visited last year. But hospitals charge more than physicians for the same office-based procedures when they own the practice. I've witnessed this with alarming frequency in Austin. My colleagues have been forced to sell their practices to large hospital corporations out of economic necessity. A hospital buys out the physician's practice, puts a new sign on the door, and then starts raising prices. By asking our leaders in Washington, D.C., to pass site-neutral payment policies, we can ensure that patients receive the same service at the same price regardless of who owns the practice. This would save Americans billions of dollars. We must take action on this critical issue without delay. Our health depends on it.
Health Affairs: Making The Promise Of Value-Based Care Meaningful To Consumers (10/5) – As value-based care models continue to improve and evolve, the definition of “value” for consumers and patients must also be broadened to include reducing inequities in access and quality. As consumer/patient advocacy members of the Health Care Transformation Task Force, a multistakeholder consortium committed to accelerating the pace of value-based care transformation, we strongly support ongoing efforts to move to a person-centered, value-based payment system that prioritizes strategies to achieve health equity. Here, we share our vision for how individuals, patients, and families can be best served by accountable care models that center on individual needs and preferences. Meaningful, equity-focused, value-based care is a promising and necessary alternative to FFS medicine. We also call for action to increase provider uptake of value-based care models and engage patients and communities in their development, implementation, and evaluation.
Axios: Doctors question Medicare quality program as more face steeper penalties (10/5) – The Merit-Based Incentive Payment System (MIPS), was designed to get tougher as providers got more accustomed to tracking quality metrics, but providers say it's causing more trouble than it's worth. Program scores don't necessarily correlate with the quality of care doctors provide, according to a JAMA study last year. CMS told Axios a voluntary MIPS reporting option that started this year, which tailors quality measures to specific specialties and conditions, is "the future of the MIPS program" and "offers a more connected assessment of quality of care." While MIPS penalties get steeper next year, a select few providers will see higher rewards than ever before, partly due to an additional bonus pool that expires next year. Congress should consider whether the current system incentivizes providers — especially larger practices — to "game MIPS" rather than strive to enter alternative payment models, he said. Physicians are lobbying Congress to make big changes to how Medicare pays them, and they hope MIPS will be part of the conversation.
Missouri Times: Opinion: Healthcare Costs Are Hurting Businesses, And That Must Be Changed (10/3) – Whether from consolidation, lack of price transparency, or a general anticompetitive behavior, spending on hospitals has easily surpassed any other component of our larger healthcare dollar. But thankfully, our elected officials have finally caught on. Last session, a bill was introduced here in Missouri that would’ve prevented hospitals from surprising consumers and health plans, which happens when hospitals reclassify a doctor’s office that they own as a hospital setting to charge more money and occurs largely because of unchecked hospital consolidation. This issue of “dishonest billing” has slowly gained momentum in state legislatures all over the country and in Washington, DC, where multiple bills targeting this billing have been introduced, including in the powerful Ways & Means Committee, chaired by Missouri’s own Jason Smith.
RevCycle Intelligence: How Vermont’s All-Payer ACO Model Paves the Way for Value-Based Care (10/3) – This article breaks down how the Vermont All-Payer ACO Model was developed, how the model impacted health care quality and spending, the strategies behind the model’s success, and the challenges encountered by the sole participating ACO. States will be looking to CMS to see where the agency is going with their payment models, particularly at models that impact Medicare reimbursement, as the public program often sets the stage for reimbursement methods in all-payer arrangements. Multi-state agreements are another potential pathway to value. But CMS must ensure there is enough flexibility within models to meet the needs of different states and encourage providers and payers to participate.
CBS News: Who polices hospitals merging across markets? States give different answers (9/28) – Cross-market deals accounted for more than half of all hospital mergers and acquisitions during the last decade, according to a paper from experts on antitrust law. Today, nearly 60% of health systems operate multiple hospitals in different geographic markets. Not only are such deals more common, they can increase costs for patients. Merged hospitals in the same state but in different markets raised prices as much as 10% compared with other hospitals, researchers found after analyzing past deals. A separate study found stand-alone hospitals raised prices 17% after they were acquired by a hospital company in another market. The Federal Trade Commission and the Justice Department are reviewing public comments on draft merger guidelines designed to crack down on mergers in multiple sectors, including health care. It's not yet clear if or how cross-market hospital mergers within a state could be affected. Still, the draft says consolidation should not "entrench or extend a dominant position" by extending into "new markets."
Health Affairs: Embedding Equity In Financial Benchmarks: Changes To The Health Equity Benchmark Adjustment (9/28) – A key equity-oriented feature in ACO REACH is the Health Equity Benchmark Adjustment (HEBA). As its name suggests, the adjustment permits increases or decreases to participants’ financial benchmarks based on the characteristics of beneficiaries served. The intent is to mitigate disincentives to serve historically marginalized populations by acknowledging the potential additional costs associated with caring for these groups and reflecting those in financial performance targets. The stakes are high for HEBA updates: it is one of the first efforts – if not the first – to change financial targets based on traditionally non-medical factors; and ACO REACH is the first major model to incorporate this type of equity adjustment at scale. This article reviews how the HEBA is currently assessed; how it is outlined to change; and several key policy implications.
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