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: (4/12) – CMS released the final evaluation report for the Bundled Payment for Care Improvement (BPCI) Initiative. The independent evaluation found that BPCI resulted in reduced Medicare fee-for-service payments while maintaining the quality of care for Medicare beneficiaries. Medicare experienced net losses under Model 2 and 3 after taking into account reconciliation payments to participants. Elimination of the repayment responsibility for the early portion of the Initiative was a major reason for these losses. Findings at a Glance
CMS: (4/12) – CMS released the BPCI Advanced (BPCI-A) Model second annual report. Early evidence indicates that participating hospitals reduced Medicare fee-for-service payments for most of the clinical episodes evaluated while maintaining quality of care. However, Medicare experienced net losses in the first 10 months of the model after accounting for reconciliation payments, underscoring the challenges of identifying appropriate benchmarks in setting target prices within a prospective payment framework. Findings at a Glance
CMS: (4/12) - CMS announced it will extend the deadline for interested applicants to apply to the Primary Care First Cohort 2. The deadline for PCF practice applications has been extended to May 21, 2021 and the deadline for payer applications has been extended to June 18, 2021. CMS also announced two additional Office Hour events for potential practice and payer applicants to ask questions ahead of the application deadlines.
CMS: (4/8) - CMS announced the selected applicants for the Value in Opioid Use Disorder Treatment Demonstration. Starting in April 2021, the 4-year demonstration tests whether a new care management fee and performance-based incentive for opioid use disorder (OUD) treatment services can cut hospitalizations and improve health outcomes for individuals with OUD.Information
CMS: (4/8) - CMS announced the 53 organizations participating in Performance Year 2021 (PY2021) of the Global and Professional Direct Contracting Model (GPDC), which started on April 1, 2021. CMS also announced that they will not be soliciting applications for a second round of participants to start the GPDC Model on January 1, 2022, including not accepting new applicants for the MCO-based Direct Contracting Entities.
HHS: (4/7) HHS Secretary Becerra announced that more than 500,000 consumers have already signed up for health insurance through HealthCare.gov as a result of the Biden Administration’s Special Enrollment Period (SEP) for the COVID-19 Public Health Emergency.CMS Press release Fact sheet
HHS: (4/7) - Also on April 7, HHS Secretary Becerra announced that all HRSA-funded health centers and Health Center Program look-alikes (LALs) will now be invited to participate in the Health Center COVID-19 Vaccine Program.
ASPE: (4/6) - ASPE issued a brief on characteristics of homebound older adults and potential barriers to accessing the COVID-19 vaccine. ASPE found that approximately 1.6 million adults 65 years of age and over living in the United States may have trouble accessing the COVID-19 vaccine because they are homebound; 51% of these older adults face at least one additional barrier, such as living alone or lacking technology. The brief also finds that almost all homebound older adults--96%--report having seen their doctor in the past year and suggests working more closely with primary care providers and health centers may also benefit vaccination efforts.
Better Way for Providers to Repay Act: (4/8) - Reps. Issa (R-CA), Levin (D-CA), Calvert (R-CA) and Correa (D-CA) introduced the Better Way for Providers to Repay Act (H.R.2407), which would provide for a 3-month delay for the recoupment of certain payments made under the accelerated or advance payment programs under the Medicare program.
H.R. 2356 : (4/5) - Reps. Butterfield (D-NC) and Mullin (R-OK) introduced legislation (H.R.2356) which would make technical amendments to the separate payment under the Medicare program for disposable negative pressure wound therapy devices.
Florida Medical Association:(4/13) - The Florida Medical Association released a paper on the information blocking provision of the 21st Century Cures Act, outlining background information on the rule and what the rule means for physician practices.
Aledade:(4/12) - In this episode of the Aledade ACO Show Podcast, Ron Holder, COO of MGMA, discusses the different challenges practices face and how MGMA helps provide solutions and support.
Modern Healthcare: (4/9) - In this blog, MGMA President and CEO Dr. Halee Fischer-Wright reflects on the impact COVID has had on health care providers, amplifying physician burnout that existed prior to the pandemic. She emphasized the need to address the impending physician shortage, for organizations to address operational dysfunction and administrative burden, and to recognize that providers are in crisis and to financially invest in their well-being.
HCP LAN: (4/13) - The LAN announced it will launch a Primary Care/Population Health Action Collaborative (PC/PH AC). The goal of the Collaborative is to accelerate adoption of resilient, population-based APMs with prospective cash flows for primary care providers and to achieve more equitable outcomes in PC/PH APMs.
Managed Healthcare Executive: (4/12) - In this article, CEO and co-founder of LeadingReach Curtis Gattis discusses how health care organizations participating in risk-based contracting or value-based care models are facing major challenges with integrating, managing, and tracking care coordination and communication capabilities within provider networks. Identifying care coordination goals are critical for improving value-based processes, and the following four goals could help improve care coordination: digitize referral communication; redirect referrals to in-network providers; add specialists notes to the EHR; and check the status of patients.
Health Affairs: (4/12) - The majority of US metropolitan residents live in highly concentrated hospital markets, largely as a result of health care consolidation. COVID-19 has exacerbated this trend, putting pressure on independent physicians to consider both horizontal and vertical mergers and transition to an employed model. This blog reviews policy interventions to address hospital consolidation and outlines the history, challenges and promise of physician-owned hospitals, which are split between community hospitals and specialty surgical hospitals.
Health Affairs: (4/9) - Accountable care organizations (ACOs) have been a mechanism for moving the health care system toward value-based care, with ACO models in the Medicare program consistently achieving gross savings and improved quality. This blog makes the case for sustaining the value movement by calling on the Biden Administration to make the Next Generation ACO model a permanent option for providers and prioritize expansion and improvement when reviewing the model.
Forbes: (4/9) - In his new role, HHS Secretary Xavier Becerra is likely to focus on anti-competitive practices in the health care system given his track record with anti-trust and other issues during his time as California Attorney General. Becerra has previously addressed health care competition and antitrust matters when he oversaw the largest health care antitrust settlement in the history of the US with Sutter Health, and has pushed for regulatory reforms to address anti-competitive practices.
Revcycle Intelligence: (4/8) - According to a new report from Kaufman Hall, hospital merger and acquisition (M&A) activity decreased significantly in the first quarter of 2021 despite larger than average transaction sizes. Only 13 M&A deals were announced at the start of 2021, with the average selling size reaching $676 million.
Healthcare Exec Intelligence: (4/7) - This article gives an overview of CMS actions taken thus far in 2021, which include recouping accelerated, advance payments made to providers through COVID-19 Accelerated and Advance Payments, delaying a request for applications for the ACO Transformation Track of the CHART Model, and instructing the Medicare Administrative Contractors (MACs) to withhold all claims with dates of service on or after April 1 due to an extension of the Medicare sequester.
MedCity News: (4/7) - President Biden has been laser-focused on expanding access to quality, affordable health care and reducing health disparities since taking office. As COVID-19 has highlighted the urgent need for a value-driven health care system, it presents a significant opportunity for the Biden Administration to focus on value-based care. The Administration could capitalize on technology breakthroughs and other reforms that expand access to care to advance the next generation of value-based care in advanced APMs and to create a more equitable, efficient health care system.
Wall Street Journal: (3/22) - Although hospitals are now required to make their prices for services public to comply with a new federal rule, a Wall Street Journal examination of 3,100 sites revealed that hundreds of hospitals have embedded code that has blocked this information from being searched. While the prices are often accessible other ways, the code keeps pages from appearing in searches, inhibiting patients ability to easily find the information they are looking for.