News Clips
Healthcare Dive: (1/31) – Brookings Institution and University of Southern California researchers argue that proposed changes to CMS’s risk adjustment methodology could have the opposite effect and should be abandoned. CMS is proposing to recalculate parameters for the risk score methodology, including adding a two-stage weighted approach, starting in the 2023 benefit year. The goal is to improve the model's accuracy in predicting risk in subpopulations, with the broader aim of further reducing premiums on the cheaper plans favored by lowest-risk people.
Modern Healthcare: (1/31) – Doctors employed by health system-owned practices are paid mostly for the amount of services they provide, even as payers strive toward value-based care, the RAND Corp. reports. The findings, published on JAMA Health Forum, show that volume counted towards compensation for 83.9 percent of primary care physician organizations and 93.3 percent of specialty organizations. Performance-based initiatives averaged less than 10 percent of compensation for the practices surveyed.
Fierce Healthcare: (1/31) – Oncology practices are trying to figure out their next steps for value-based care as a popular payment model concludes in June with no successor in place, with providers worried that access to services will decline. Oncologists told a survey conducted by the advocacy group Community Oncology Alliance they are worried that access to care could be reduced without a successor and that staff responsible for navigating value-based care may be laid off.
Axios: (1/27) – The number of Medicare accountable care organizations has flat-lined since 2018,according to new CMS data. Additionally, 41 percent of all Medicare ACOs are still in what's called "one-sided" models (and that number used to be higher than 80 percent).ACOs have scored well on quality and saved some money, but those savings are minuscule — just 0.5 percent of Medicare's "fee-for-service" spending.
Modern Healthcare: (1/27) – Female clinicians spend more time filling out patients' electronic health records and thus treat fewer patients, according to a new study that highlights the economic effects of a volume-over-value payment model on women in the workforce. Athenahealth analyzed how 14,520 clinicians used its record systems over a five-month period last year and discovered that female clinicians see fewer people per week than their male counterparts because they devote more time to documenting patient encounters.
Health Affairs: (1/27) – CMS leadership has outlined bold strategic plans to improve its value-based care programs, but these changes alone may not achieve optimal results. That is due, in part, to: dynamics already in place around commercial plan-provider relationships; lopsided market leverage between “must-have” providers and health plans that cannot sell products without including those providers in their networks; and structural inequities in resources available to different providers. Each of these factors, alone and in combination, poses critical barriers to successful value-based payment.
Kaiser Health News: (1/27) – A political battle over a proposed expansion by the largest and most expensive hospital system in Massachusetts is spotlighting questions about whether similar expansions by big health systems around the country drive up health care costs. Mass General Brigham, which owns 11 hospitals in the state, has proposed costly expansions to its existing facilities including three comprehensive ambulatory care centers. On Jan. 25, the state’s 11-member Health Policy Commission unanimously concluded that these expansions would drive up spending for commercially insured residents by as much as $90 million a year and boost health insurance premiums.
Fierce Healthcare: (1/26) – Calls are mounting among industry and legislators for a federal investigation into potential price gouging by nurse staffing agencies that have found their services in high demand throughout the COVID-19 pandemic. Tuesday, a bipartisan group of almost 200 lawmakers penned a letter to White House COVID-19 Response Team Coordinator Jeffrey Zients asking the official “to enlist one or more” federal agencies to open an investigation into potential anti-competitive activity or violation of consumer protection laws.
Fierce Healthcare: (1/26) – The number of accountable care organizations participating in the Medicare Shared Savings Program (MSSP) modestly increased to 483 this year compared with 477 for 2021, sparking new worries from advocates over the future of the program. But the number of beneficiaries who are cared for by an ACO continues to grow. As of Jan. 1, 2022, more than 11 million Medicare beneficiaries get care from a provider in an MSSP ACO, up by 340,000 (3 percent) from 2021, CMS' analysis said.
Fierce Healthcare: (1/25) – A Wisconsin judge has lifted a temporary restraining order that prevented Ascension from hiring seven technicians and nurses previously employed at ThedaCare, an eight-hospital system that said losing the staff would impede its trauma victim care. ThedaCare initially told a county circuit court judge that Ascension had recruited the majority of its interventional radiology and cardiovascular team and “set the stage for their simultaneous departure.”
Modern Healthcare: (1/25) – KPMG surveyed more than 300 health care executives and found that 70 percent expect to increase their merger and acquisition activity this year. More than half of private equity investors in those sectors reported they plan to participate in at least 10 percent more deals than during 2021, a year heavily impacted by the ongoing COVID-19 pandemic.According to KMPG, there were 1,839 healthcare and life sciences deals in 2021, up 13.7 percent from 2020 and 19.2 percent from 2019, the year before the pandemic began. Deals per quarter averaged 460 in 2021 compared with 405 in 2020 and 385 in 2019.
Axios: (1/25) – Mass General Brigham must submit a plan to lower rising costs that stem from the hospital system's expensive care, the Massachusetts Health Policy Commission said. Mass General Brigham — the dominant, tax-exempt academic hospital organization in Massachusetts with $16 billion of annual revenue — has the highest prices in the state.The system's market power has led to residents paying a lot more in health insurance premiums and taxes, and that higher spending "raises significant concerns" and is "likely to continue to impact the state's ability to meet" a benchmark of lower cost growth, the commission said.
Milbank Memorial Fund: (1/24) – In 1981, researchers developed a model that breaks down the concept of primary care access into five factors: availability of primary care clinicians; geographic access; appointment availability and hours; affordability; and comfort and communication between patient and clinician. The authors of this report reviewed the research literature to assess the evidence supporting whether policy initiatives targeting primary care access in each of these five dimensions have been effective in reducing health care disparities.
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