News Clips
Third Way: An Agenda to Fix America’s Broken Hospitals (1/4) – Rising hospital prices are the direct result of the consolidation of hospitals into big systems that stifle competition. Four out of every five hospital markets are highly consolidated, and half of the nation’s physicians are hospital employees. Consolidation drives up prices and subverts the competition needed to keep costs in check. Nine out of ten voters say it is important for Congress to reduce hospital prices. Third Way’s Fixing America’s Broken Hospitals series provides a framework for how Congress can: lower the prices charged by hospitals; increase competition within health care; and lower patients’ costs at safety net hospitals.
Health Affairs: Dispelling The Myths Hindering Medicaid Innovation (1/4) – A lack of funding for startups in Medicaid exists despite 84.5 million individuals, or more than one-quarter of the US population, being enrolled in the Medicaid program as of July 2023. This discrepancy begs the question: Why is there a dearth of innovation for Medicaid beneficiaries? Based on our experience working with startups and conversations with health care leaders in investing, entrepreneurship, and government, we conclude that pervasive half-truths, or “myths,” about Medicaid hinder innovation and optimal funding from entrepreneurs and investors. In this article, we examine these myths and propose ways for entrepreneurs, investors, and policy makers to collectively evolve and improve care for Medicaid beneficiaries.
Kaiser Family Foundation: The CBO Report That Didn’t Roar (1/4) – A Congressional Budget Office report in September slipped through the health universe garnering some attention from health policy insiders, but not enough, going largely unnoticed by the larger health community despite its potentially broad implications for efforts to promote value through popular payment changes. Not necessarily in response to the report, CMS may now also be hedging its bets, focusing on a more multipronged cost strategy than in the past. CMS’s goal remains to see every Medicare beneficiary in some form of accountable care arrangement in seven years. And recently former HHS Secretary Azar called for an end to demos altogether, feeling value-based payment was the way to go. After all, Medicare spending growth has slowed in recent years. While the full explanation for that is not well understood, it’s possible that the drive towards value-based payment and accountable care has changed provider attitudes and behavior and is part of the explanation, though that is difficult to quantify. Still, Medicare spending is expected to accelerate in the future.
JAMA: Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure (1/3) – CMS’ Bundled Payments for Care Improvement (BPCI) program was launched in 2013 with a goal to improve care quality while lowering costs to Medicare. In this study, hospital participation in the BPCI Model 2 Heart Failure program was not associated with improvement in process-of-care quality measures or 30-day or 90-day risk-adjusted all-cause mortality and readmission rates.
Healthcare Finance: ACOs and physician group call for removal of financial penalties in information blocking rule (1/3) – The National Association of ACOs (NAACOS) is asking for changes to the information blocking rule prohibiting participation in the Medicare Shared Savings Program if the ACO or its clinicians for noncompliance. Prohibiting ACO participation as a penalty for information blocking penalizes patients by blocking participation in value-based models aimed at improving patient care, NAACOS said. It advises CMS and the ONC to apply a corrective action plan for information blocking, rather than imposing financial penalties.
Washington Post: HHS plan to revitalize U.S. primary care falls short, experts say (12/29) – In a bid to rectify key failings in the country’s fractured health care system, the Biden Administration released plans to shore up primary care. The report outlines some steps to change the financial incentives that have hampered access to primary care. It draws extensively on recommendations published in 2021 by the National Academies of Sciences, Engineering, and Medicine that called for a shift away from the fee-for-service system, which rewards physicians for treating sick people rather than for preventing them from becoming ill in the first place. “Primary care is one of the few interventions that has been shown to improve health outcomes,” said Shantanu Nundy, a primary care physician who works for a virtual care company and at a federally qualified health center. The current system devalues routine preventive care in favor of expensive treatments, he said, and “Americans are living poorer-quality and shorter lives as a result.”
New York Times: Serious Medical Errors Rose After Private Equity Firms Bought Hospitals (12/26) – The rate of serious medical complications increased in hospitals after they were purchased by private equity investment firms, according to a major study of the effects of such acquisitions on patient care in recent years. The study, published in JAMA, found that, in the three years after a private equity fund bought a hospital, adverse events including surgical infections and bed sores rose by 25 percent among Medicare patients when compared with similar hospitals that were not bought by such investors. The researchers reported a nearly 38 percent increase in central line infections, a dangerous kind of infection that medical authorities say should never happen, and a 27 percent increase in falls by patients while staying in the hospital. Over the last two decades, private equity firms have become major players in health care, purchasing not just hospitals but also a growing number of nursing homes, physician practices and home health care companies.
The Hill: Private equity is buying up health care, but the real problem is why doctors are selling (12/21) – Over the last decade, private equity firms have spent nearly $1 trillion on close to 8,000 health care deals, snapping up practices that provide care from cradle to grave: fertility clinics, primary care, and everything in between. But amid warnings that private equity is taking over health care and portrayals of financiers as greedy villains, we’re ignoring the reality that no one is coercing individual physicians to sell. Running a private practice has become increasingly unsustainable, and alternative employment options, such as working for hospitals, are often unappealing. That leaves private equity as an attractive third path. There are plenty of short-term steps that regulators should take to keep private equity firms in check. But the bigger problem we must address is why so many doctors feel the need to sell. The real solution to private equity in health care is to boost competition and address the pressures physicians are facing.
Health Affairs: Engaging Specialists In Accountable Care: Tailoring Payment Models Based On Specialties And Practice Contexts (12/26) – This article discusses how differences across specialty care providers and practice contexts should inform accountable care strategies, especially to achieve effective specialty care engagement and strengthen primary/specialty collaboration. These concepts are presented in three sections: describing how different types of specialty care can be engaged in accountable care models, outlining how the practice environment (such as different types of ACOs) affects specialist engagement, and considering the policy and implementation implications for engaging different types of specialists in different contexts. In Part two, we will present concrete recommendations for modifying ACO design and implementation to improve specialty care engagement.
STAT: Why haven’t health care cost increases exceeded inflation? There’s a very good reason (12/21) – Today, controlling costs is on every orthopedist’s mind, and they are not alone. The catalyst for this change in attitude is payment-driven by the evolving shift from fee-for-service to value-based payment, from paying physicians to do more tests and treatments to paying them to improve health and prevent expensive disease exacerbations. In fact, CMMI was responsible for shifting Medicare from essentially no value-based payments — in which providers are responsible for quality and total cost of care — in 2012 to more than 30 percent of payments by 2016. This was the largest shift in Medicare payment in history and was a catalyst for change in the broader health care system.
Modern Healthcare: Doctors, hospitals face cuts as Congress takes Christmas off (12/21) – When Congress went on its winter break before Christmas, it left much of its healthcare business unfinished, and now faces an intense scramble to get it all done in just weeks. Congress will certainly miss at least one deadline. The 3.4 percent cut to physician payments the CMS announced in November kicks in on Jan. 1, and Congress has not addressed that cut in stopgap bills, leaving doctors disappointed and hoping for future redress. "In any given budget cycle, they're just maybe looking to save a buck here or there, but it honestly doesn't make sense to me," said Dr. David Eagle, a Patchogue, New York-based hematologist-oncologist and vice president of the recently created American Independent Medical Practice Association.
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