Welcome to this week's edition of the 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.
CMS: (3/30) - CMS announced the Community Health Access and Rural Transformation (CHART) Model ACO Transformation Track Request for Applications release date is delayed from spring 2021 to spring 2022. This delay applies only to the ACO Transformation Track of the CHART Model, and stakeholders will be notified as more information becomes available.
HHS: (3/29) - HHS, through a partnership with CDC and the Administration for Community Living (ACL), announced it will provide $100 million to help increase vaccinations among older adults and people with disabilities. ACL will issue nearly $93 million in grants to the aging and disability networks in every state and territory to provide critical services to overcome barriers to vaccination for those most at risk of serious illness or death from COVID-19. The partnership will also provide $5 million in funding for national hotlines to assist older adults and people with disabilities in registering for a vaccine appointment and to connect them with local agencies that can provide services and supports to access them.
White House: (3/25) - President Biden announced nearly $10 billion to expand access to vaccines and better serve communities of color, rural areas, low-income populations, and other underserved communities in the COVID-19 response. HHS will invest more than $6 billion from the American Rescue Plan into Community Health Centers nationwide, and CDC will invest $3 billion to support local efforts to increase vaccine uptake and equity. CDC will also provide $300 million to jurisdictions for community health worker services to support COVID-19 prevention and control, and an additional $32 million for training, technical assistance, and evaluation. Finally, the Administration is announcing a new partnership with dialysis clinics to provide COVID-19 vaccinations to people receiving dialysis and health care personnel in outpatient dialysis clinics.CDC Press release
CMS: (3/24) - CMS released an updated data snapshot detailing the impact of COVID-19 on Medicare beneficiaries from January 1, 2020, to December 26, 2020, particularly among underserved beneficiaries including racial and ethnic minorities, adults 85 years old and older, and people with certain pre-existing conditions. More than 2.7 million beneficiaries were diagnosed with COVID-19 during the snapshot period, and nearly 700,000 beneficiaries were hospitalized with COVID-19.
H.R. 1868: (3/25) - The Senate passed with an amendment H.R. 1868, which would prevent across-the-board direct spending cuts by exempting Medicare from sequestration until December 31, 2021. The package of bills includes the Rural Health Clinic Act (S.935), which would make technical corrections to rural health clinic payments. The package now moves back to the House for consideration.
CHOICE Act: (3/25) - Sen. Whitehouse (D-RI) introduced the Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act (S.983), which would amend the Patient Protection and Affordable Care Act to establish a public health insurance option.
Healthcare Workforce Resilience Act: (3/25) - Sens. Durbin (D-IL), Cornyn (R-TX), Leahy (D-VT), Young (R-IN), Coons (D-DE) Collins (R-ME) introduced the Healthcare Workforce Resilience Act (S.1024), which would enhance our Nation's nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas.
Safe Step Act: (3/23) - Reps. Ruiz (D-CA), Wenstrup (R-OH), McBath (D-GA) and Miller-Meeks (R-IA) introduced the Safe Step Act (H.R. 2163), which would amend the Employee Retirement Income Security Act of 1974 to require a group health plan or health insurance coverage offered in connection with such a plan to provide an exceptions process for any medication step therapy protocol.
Aledade: (3/29) - In this episode of The ACO Show, Aledade hosts are joined by Dr. Derek Lewis, the CEO, owner, and primary care physician at Arkansas Primary Care Clinic. They discuss the COVID-19 vaccination efforts and success in Dr. Lewis’ community. Dr. Lewis also describes the initial skepticism of vaccines in the black and brown community and how he was able to build trust with his patients.
Cal Matters: (3/24) - The American Rescue Plan will provide a $26 billion windfall to the state of California, and lawmakers are now deciding how and where to prioritize the spending of these funds. Anthony York, spokesperson for the California Medical Association, said that much of this money should go toward health care and expanding health coverage, and that the state should support small physician practices that have struggled during the pandemic and to boost the rates doctors receive from Medi-Cal.
AAFP: (3/24) - In a letter to the Senate HELP Committee ahead of a hearing entitled “Examining Our COVID-19 Response: An Update from the Frontlines,” AAFP commented on the inefficiencies and inequities in the health cares system that have been exacerbated by the pandemic. AAFP called for the federal government to take action to support access to and coverage for COVID treatment and prevention, especially for family physicians and FQHC providers.
Apple Podcasts: (3/24) - In this episode of the Florida Medical Association (FMA) Medicine, Curated podcast, FMA CEO Timothy Stapleton and Director of Health Care Policy and Innovation Jarrod Fowler discuss four pressing payment controversies all physicians should be aware of, how the FMA is addressing them, and what to expect next.
Revcycle Intelligence: (3/29) - The Southwestern Health Resources Accountable Care Network, which is one of the nation’s top-performing Next Generation ACOs, saved over $52 million in 2019, accounting for a fifth of total program savings that year and bringing individual ACO savings to $120 million since 2017. Leaders at Southwestern Health Resources attribute this success to physician-driven strategies and are using technology to redesign the physician referral process to prevent out-of-network utilization that can impact care coordination and overall success.
PitchBook: (3/26) - In its new analyst note, PitchBook outlines the potential impact that value-based care can have on emerging technology and health care at large. Highlights of the report include that Medicare will be the primary driver of value-based care models and will boost investment in technology to treat conditions common among Medicare patients.
Kaiser Health News: (3/26) - According to research from Health Affairs, facility fees are a major reason why hospital prices are rising faster than physician prices. Patients like Kyunghee Lee, who experienced a price hike that was ten times what she had traditionally paid for pain-relieving steroid injections for arthritis, are often left with the price increases, even if for the same service in the same physician office as previously rendered. Site-neutral payment policies, like what CMS has introduced, are important to curtailing facility fees to protect patients.
Bloomberg Law: (3/25) - Consolidation of physician practices is expected to grow due to the strain caused by sharp reductions in patient visits that many independent physician practices have experienced during the pandemic. As of February, physician services was one of the top five sectors for health care transactions, with 71 deals involving over a dozen physician specialties having occurred, including 16 for primary care practices. The pandemic, increased competition, and reimbursement changes continue to cause uncertainty in the health care landscape.
Health Payer Intelligence: (3/25) - A recent study in JAMA Network Open revealed that Medicare Advantage (MA) plans matched or fell below traditional Medicare’s record on 13 low-value care measures, despite payers claiming MA plans’ capacity to reduce low-value care spending for seniors. One strategy payers can use to reduce low-value care includes employing alternative payment models that incentivize value-based care, so that reimbursement for low-value services can be excluded.
Revcycle Intelligence: (3/25) - The National Association of Accountable Care Organizations (NAACOS) recently sent a letter to HHS Secretary Xavier Becerra recommending that HHS promote significant ACO growth to continue the movement toward value-based care. President and CEO Clif Gaus, ScD, outlined the cost-saving impact ACOs have had on Medicare spending and encouraged HHS to set a national goal for the majority of traditional Medicare beneficiaries in an ACO by 2025.
Johns Hopkins University: (3/23) - Regulatory changes, revised payment models, and increased private equity investments over the last decade have all led to increased consolidation in the health care industry. Health Economist Daniel Polosky has noted that private equity purchases of physician practices can reduce competition in the market and raise prices without making improvements to health care quality. He calls for transparency across the industry so watchful regulators can take action as needed.
Fee-for-Service to Value: 10 Years of Transforming Healthcare
Value-based healthcare policy developments have restructured the healthcare landscape to emphasize the delivery, measurement, and outcomes of care. Over the past ten years millions of Medicare beneficiaries have been served by innovative payment models. These innovative payment approaches have also been deployed within private coverage. Innovative healthcare providers are successfully delivering improved patient care at lower costs through two-sided risk-based payment models like bundled payment arrangements and accountable care organizations.
Join us for a virtual educational boot camp focused on understanding and implementing value-based healthcare payment and delivery system reform. You’ll also hear directly from some of the nation’s leading providers and health systems on the barriers they’ve overcome transitioning to alternative payment models and key actions Congress can take to ensure the success of value-based payment initiatives.