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News Clips
Modern Healthcare (7/23) Healthcare providers wary CMS dementia pilot will not cover costs – Hospitals, primary care practices and other healthcare providers are split over whether Medicare will pay them enough to cover dementia patients at home as part of a new pilot. Nearly 100 providers began enrolling patients July 1 in CMS’ Guiding an Improved Dementia Experience model, known as GUIDE. Another 300 others will begin enrolling patients in the program on July 1, 2025. Some participants that previously provided comprehensive wrap-around services for dementia patients at home said getting a monthly care management payment for each fee-for-service beneficiary will cover costs they had been absorbing. But others aren’t sure the reimbursement will be enough to scale up programs or cover the cost of care for these complex patients.
HCTTF (7/18) Reimagining Beneficiary Engagement in Accountable Care Models – The Health Care Transformation Task Force (HCTTF) and the National Association of ACOs (NAACOS) released a resource addressing how policies can be strengthened to improve the patient experience in value-based care arrangements. Effective communication is essential for engaging patients in accountable care organization (ACO) governance, care delivery redesign, and individual care planning, promoting person-centered care. However, many patients are unaware of their participation in ACOs, and current policies often add complexity and confusion. HCTTF and NAACOS brought together ACO and patient and consumer representatives for a roundtable discussion to develop both short and long-term policy recommendations for evolving CMS accountable care models. The recommendations focus on: beneficiary communications and education; beneficiary engagement in care delivery redesign; and beneficiary participation and input in ACO governance.
The Hill (7/18) Physician burnout is on the decline but doctors aren’t cheering – After peaking during the COVID-19 pandemic, physician burnout has dipped under 50 percent for the first time in four years, but doctors say working conditions in the medical field remain far from ideal. A survey published by the American Medical Association (AMA) this month found that 48.2 percent of physicians in 2023 experienced at least one symptom of burnout, down nearly 15 percent from when this metric peaked in 2021. “It’s good news and it’s bad news,” Steven Furr, president of the American Academy of Family Physicians, told The Hill. “It’s good news that the numbers have gone down but still they’re higher than what we’d like them to be.”
Modern Healthcare (7/17) FTC, State Scrutiny of Noncompetes Shifts Labor Market – Health systems are rethinking their use of noncompete agreements despite a Texas court ruling that may doom the Federal Trade Commission's ban on those employment contract provisions. Companies are girding for more litigation, regulation and legislation seeking to limit noncompetes, even if the FTC's effort to eliminate those agreements falls short, attorneys said. Many health care employers are turning to nondisclosure and non-solicitation provisions in place of noncompete clauses that restrict employees from working for a rival organization. If employers are still using noncompetes, physicians and other health care workers are increasingly pushing back, employment lawyers said.
Commonwealth Fund (7/17) Why Primary Care Practitioners Aren’t Joining Value-Based Payment Models: Reasons and Potential Solutions – Primary care practitioners (PCPs) enthusiasm for value-based payment (VBP) models is tempered by financial barriers, the PCP workforce shortage, and imperfect performance measures. Suggested solutions to the financial challenges include sufficient upfront primary care payments from the models and ensuring health systems transfer the value-based payments to frontline primary care practices. Solutions to the PCP workforce shortage include increasing payments, boosting supports for PCPs, and investing in primary care trainees. PCPs felt that current performance measures could be improved by swapping out condition-specific metrics for metrics that support access and continuity of primary care.
STAT (7/15) The effort to reform physician pay is set to pit primary care docs against highly paid specialists – There’s been a long lull in fighting between primary care and specialty doctors over how much they get paid by Medicare, but that truce might not last if Congress overhauls the system that determines physician payment. This year, Congress began considering changes to the Medicare physician pay system for the first time since creating the current version in 2015. Committees in the House and Senate have held hearings on the matter, including the powerful Senate Finance Committee, which recently published a 30-page paper on potential changes. For now, the doctor groups are lobbying in unison toward the same goal of increasing the pot of money for physician services, which stood at about $71 billion in 2022, or 16% of Medicare fee-for-service spending. Those demands would pit doctors against others in the health care system, including hospitals, because Congress typically requires that increases in Medicare spending be paid for by cuts elsewhere in the program. That’s a heavy lift. Congress has been considering equalizing certain Medicare payments between hospitals and physicians’ offices to save money, but that site-neutral policy has faltered.
Health Affairs (7/12) Underregulated Nonprofit Hospitals: Hindering Competition Without Benefitting Communities – Given that nonprofit hospitals comprise 58 percent of community hospitals, socioeconomically disadvantaged populations often turn to nonprofit hospitals to receive care. Yet, a lack of a minimum requirement to demonstrate community benefit has nonprofit hospitals skirting their patient responsibilities while also engaging in acquisition maneuvers to limit competition. Unless better definitions and regulations become reality, the actions of these hospitals will continue to hurt the patients who need help the most.
The Hill (7/11) Why has Medicare’s Innovation Center failed? – op-ed by Chris Pope, Manhattan Institute – It has been hard for the Innovation Center to establish appropriate “value-based payment” rates. The cost of treating a patient with heart disease will vary greatly according to his or her specific co-morbidities and risk of complications. Concerns that payment incentives would lead medical providers to avoid high-risk patients or to withhold costly drugs from seriously ill cancer sufferers have deterred the center from requiring providers to participate. As a result, most Innovation Center models have been established on a voluntary basis, and medical organizations have insisted on being paid more in return for bearing additional risk. As the center has typically based benchmarks on average patient costs, these have tended to only attract providers which already had below-average expenses — rewarding them for “savings” they did nothing to deserve.
New York Times (7/10) In Constant Battle With Insurers, Doctors Reach for a Cudgel: A.I. – For a growing number of doctors, A.I. chatbots — which can draft letters to insurers in seconds — are opening up a new front in the battle to approve costly claims, accomplishing in minutes what years of advocacy and attempts at health care reform have not. Some experts fear that the prior-authorization process will soon devolve into an A.I. “arms race,” in which bots battle bots over insurance coverage. Among doctors, there are few things as universally hated. Generative A.I. has been particularly useful for doctors at small practices, who might not ordinarily have time to appeal an insurer’s decision — even if they think their patient’s treatment will suffer because of it.
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