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.
The next edition of the PEPC newsletter will be sent on January 4th. Wishing you a very happy holiday season!
HHS: (12/20) – In support of President Biden’s Executive Order on Promoting Competition in the American Economy, HHS released ownership data for all Medicare-certified hospitals. This will enable the public to review detailed ownership information on the more than 7,000 hospitals certified to participate in the Medicare program.
Consolidated Appropriations Act, 2023: (12/20) – The Fiscal Year 2023 Consolidated Appropriations Act includes appropriations for fiscal year 2023 and several key health care extenders and new authorizations. If passed, the bill would extend the alternative payment model (APM) bonus for one year at a rate of 3.5 percent and reduce Medicare physician payments by two percent in 2023 and 3.25 percent in 2024. This is a slight relief from the 4.5 percent reduction physicians were facing. Bill Text
Rep. Spartz (R-IN): (12/19) – Rep. Spartz (R-IN) wrote an op-ed in The Hill, “Hospital monopolies are destroying health care value,” in which she states she joined the GOP Healthy Future Taskforce to develop policy solutions to address the increased consolidation, elimination of competition, and rising prices in health care. In 2022, Rep. Spartz introducedlegislation to remove barriers to competition and make health care more affordable for all Americans.
House GOP Doctors Caucus: (12/15) – The House GOP Doctors Caucus led a letter signed by 83 representatives to Congressional leadership urging action to prevent looming Medicare payment cuts. Letter
Reps. Wild (D-PA) and Miller-Meeks (R-IA): (12/14) – Reps. Wild (D-PA) and Miller-Meeks (D-IA) led a bipartisan letter signed by 113 representatives urging President Biden and Congressional leadership to take action to prevent looming Medicare cuts.
Medical Group Management Association: (12/20) – Medical Group Management Association (MGMA) released a statement on Medicare cut provisions included in omnibus draft, noting that “On behalf of our nation’s medical groups — ranging from small physician practices in rural areas to large regional and national health systems — MGMA is deeply dismayed by the failure of Congress to adequately address the full 4.5 percent cut to the Medicare conversion factor set to take effect on Jan. 1.”
Med City News: 2023 Will Be a Year of Shrinking Margins and More Consolidation for Hospitals, Expert Says (12/20) – Inflation and shrinking operational margins are among the key factors that will influence hospitals and health systems’ strategies in 2023, according to a new analysisfrom Deloitte. Shrinking margins are not going to be sustainable for all hospitals, with small and rural hospitals being the most vulnerable. As a result, 2023 will see more hospitals merging or shutting down. “These smaller and midsize hospitals are just getting hammered, and a lot of them are facing bankruptcy or even just shutting their doors.”
Kaiser Health News: Medicare Pay Cuts Will Hurt Seniors’ Care, Doctors Argue (12/20) – A more than 4,000-page draft government spending bill released by lawmakers early Tuesday morning proposed much smaller-than-planned cuts to Medicare payments. But the bill, which Congress hoped to pass by the weekend to keep the government funded and avert a shutdown, would not go as far as doctors wanted. The Medicare Payment Advisory Commission (MedPAC) has expressed concern about certain Medicare payments for primary care and has reported that, from 2015 through 2020, the number of primary care physicians treating Medicare beneficiaries dropped from 2.8 to 2.4 per 1,000 beneficiaries.
Healthcare Innovation: Evaluation Details Progress on Primary Care First Model (12/20) – An evaluation of the first year of the CMS Innovation Center’s Primary Care First (PCF) model found that by using care management strategies, practices are seeking to reduce readmissions through improved post-discharge follow-up and fewer preventable hospitalizations among patient subgroups with complex conditions. A preliminary review of data suggests most practices in Cohort 1 of the model will meet benchmarks for quality measures related to diabetes control, high blood pressure control, and colorectal cancer screening.
Medical Economics: Four factors that will likely affect health care in 2023 (12/20) – Transitioning to new payment models, such as value-based care, was seen as the top priority among health plan executives according to an analysis from Deloitte. Many health plans are likely to enter the new year in a strong financial position due to fewer health care claims in 2022. Hospitals and health systems, on the other hand, will be more focused on slowing losses in 2023. That could make it difficult for health plans to move their network providers into new payment models. The expectation is that most health plans will see profitability in 2023, but hospitals and health systems are probably facing another challenging year as they try to balance financial pressures with the need to invest in the future while ensuring high-quality care.
Forbes: The Case For Greater Focus On Innovation In Medicare Advantage - op-ed by Sachin Jain, CEO of SCAN Health Plan (12/16) – With roughly 50 percent of Medicare beneficiaries now in the Medicare Advantage program, it has been under-represented in the government’s innovation portfolio. Enhanced Innovation Center focus on Medicare Advantage could focus on new solutions to address the set of acknowledged challenges with the program. One set of models could focus on introducing new ways of identifying and rewarding risk that leverage data and real-time adjudication. A second set of models could focus on new methods of quality measurement and modernizing the Star Ratings program. A third set of models could focus on special populations presently underserved by the Medicare program. CMS and the Innovation Center must continue its work on behalf of all beneficiaries and rapidly accelerate the work of improving its administration of the Medicare Advantage program.
Washington Examiner: Dishonest hospital billing is driving up healthcare costs (12/16) – More and more physicians are closing or selling their independent practices and joining larger hospital systems that have near-monopolies in their areas. The American Medical Association reports that the number of physicians employed at hospitals increased by roughly 50 percent between 2012 and 2020. Also, as of 2020, a majority of physicians were working for these large hospital systems rather than independently in private practice for the first time. This lack of competition in and of itself results in higher prices for employers, their employees, and families. But when hospitals take advantage of this structure to charge an unjustified hospital premium, the cost of health care becomes unsustainable.
Forbes: Delivering Equitable Healthcare Through Technology (12/15) – Today's health care landscape faces a multitude of challenges driven by fragmented care. According to an international survey by The Commonwealth Fund, primary care doctors in the U.S. more frequently struggle to coordinate patient care and communicate with other health care providers when compared to providers in the other high-income countries surveyed. To address these health disparities, the current administration has implemented a strong focus on health equity. Achieving these objectives will involve a mix of foundational, legislative and organizational changes in addition to the health care industry leveraging technology to deliver more equitable, streamlined health care that benefits providers, patients, health plans and the system overall.
Med City News: Health Equity and the Push to Value-Based Care (12/14) – Social, economic, and geographic disadvantages create significant disparities in health care. To help improve these issues, CMS redesigned the Global and Professional Direct Contracting Model under the new name, the ACO REACH Model. This new model will test ways to address health inequities by focusing on alternative payment structures that could better support accountable care delivery and care coordination. To effectively reduce disparities and improve the quality and coordination of care, government, providers, and health care organizations are beginning to collaborate on how to best address the factors driving gaps between populations. ACO REACH is another step in the right direction. As all parties start to implement the right procedures to abide by the new policies, we will begin to improve inequities in health care.
Fierce Healthcare: Last-minute Senate bill seeks to extend value-based care doc bonus for another 2 years (12/14) – A new bipartisan Senate bill aims to extend for two years five percent bonus to doctors who participate in alternative payment models, with lawmakers having little time to get it through Congress before the holidays. Provider advocacy groups lauded the bill as a critical tool that will help get more doctors into value-based care. “We need to encourage more health care innovation—not pull the rug out from under the people who are making the system work better for everyone,” said Whitehouse in a statement. “There is strong bipartisan support for our proposal to allow these providers to continue delivering high-quality coordinated care.”
Healthcare Innovation: Fowler Describes CMMI’s Challenges, Work on New Payment Models (12/14) – On Dec. 12, Elizabeth Fowler, Ph.D., J.D., the director of CMMI, engaged in a lively Q&A with the Penn Medicine community in Philadelphia moderated by Rachel Werner, M.D., PhD., the executive director of Penn’s Leonard Davis Institute of Health Economics. “I think that what we saw during the pandemic was that providers who were in value-based care models or in value-based care arrangements were more resilient. They had a more stable and predictable stream of income. They had created those links with community-based providers; they knew more about their patients, and where those patients were in their health care journey compared to providers who were solely dependent on fee for service.
JAMA: Comparison of Care Quality Metrics in 2-Sided Risk Medicare Advantage vs Fee-for-Service Medicare Programs (12/14) – In this cohort study, physicians in a two-sided risk Medicare Advantage model provided care of higher quality and efficiency compared with those practicing in a fee-for-service Medicare program in all eight metrics measured. The improvements observed in this study may be partly or fully attributed to the Medicare Advantage model. The Medicare Advantage risk adjustment system appears to be meeting its intended goal by aligning the capitation payments to the health care burden of the individual beneficiary and aggregate population served, thus providing revenue to develop infrastructure that supports improvements in quality and efficiency for the patients enrolled in Medicare Advantage models with 2-sided risk.