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.
PEPC: (9/28) – PEPC and over 800 physician and health care associations, health systems, provider practices, and accountable care organizations (ACOs) sent a letter to Congressional leaders calling for the extension of the Medicare Advanced Alternative Payment Model (APM) Incentive Payments. The incentive payments, which are set to expire at end of 2022, not only encourage physicians and other health care providers to enter APM models, but also provide additional resources that can be used to expand services beyond traditional fee-for-service (FFS).
PEPC: (9/28) – PEPC released a statement applauding the Biden-Harris Administration for hosting the White House Conference on Hunger, Nutrition, and Health, which unveils a national strategy to meet the goal of ending hunger and increasing healthy eating and physical activity by 2030. PEPC continues to advocate for value-based care as one way to address social determinants of health and was pleased to see the inclusion of several provisions in the Strategy supporting value-based care, including that CMS will considering extending and broadening access to the Medicare Advantage Value-Based Insurance Design (VBID) model.
CMS: (9/27) – CMS released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D income-related monthly adjustment amounts. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible in 2022.
U.S. Senate: (9/27) – Senate leaders unveiled a stopgap funding bill to fund the government through December 16th. The continuing resolution includes several health provisions, including extending the Medicare Dependent Hospital Program funding and additional funding for the 9-8-8 Suicide and Crisis Lifeline’s prevention and behavioral health services. Notably, most provisions relevant to PEPC, including the Medicare Advanced APM Incentive Payments, do not expire until the end of the year and PEPC
will advocate for their inclusion in the next package.
House Republicans: (9/22) – House Republicans released their “Commitment to America” policy platform. The platform’s health care priorities include: improving health outcomes and ensuring better care by personalizing care to provide affordable options and better quality, delivered by trusted doctors and hospitals; lowering prices through transparency, choice, and competition; investing in lifesaving cures; and improving access to telemedicine. Press Release. PEPC has sent a letter to GOP Healthy Future Task Force Chairs Reps. Guthrie (R-KY) and Nunes (R-CA) supporting provisions emphasizing value-based care and addressing harmful consolidation. PEPC will continue to engage with the Task Force as the effort continues.
Aledade: (9/27) – Aledade
released a factsheet “The Cornerstone of Value-Based Care: 4 Facts About Annual Wellness Visits.” The document highlights that Medicare Annual Wellness Visits (AWVs) shift the patient-doctor relationship from reactive to proactive, lead to better health outcomes and lower costs of care, and help physicians stay up-to-date with the proper diagnosis documentation for Medicare beneficiaries. The factsheet also notes the importance of a team-based approach in delivering a successful AWV.
Aledade: (9/26) – Aledade posted a blog highlighting additional payer contracting opportunities for primary care organizations beyond the Medicare Shared Savings Program (MSSP) including Medicare Advantage, commercial health insurance plans, and Medicaid.
MGMA, AAFP: (9/26) – Medical Group Management Association (MGMA), American Academy of Family Physicians (AAFP), and eight other stakeholder organizations sent a letter to HHS Secretary Becerra urging HHS to postpone the upcoming October 6th information blocking compliance deadlines given significant knowledge gaps and confusion within the provider and vendors communities with respect to implementation and enforcement of regulations.
MGMA: (9/21) – MGMA examined the projected impact of the impending 8.5 percent cut to Medicare rates in 2023. According to 92 percent of surveyed group practices, Medicare rates in 2022 were already inadequate to cover the cost of furnishing care. In anticipation of these reductions to Medicare payment and to ensure the financial solvency of their operations, over half of medical groups report they are considering limiting the number of new Medicare patients served, among other options such as reducing their participation in value-based payment contracts as limited resources and revenue are diverted away from non-essential practice activities. MGMA urges Congress to act expeditiously to prevent the looming 2023 Medicare physician payment crisis.
American Medical Association: (9/27) – This article offers advice to health systems considering value-based contracts from Dr. Philip M. Oravetz, chief population health officer at Ochsner Health. Dr Oravetz highlights the importance of a “quadruple aim” of value: improving population health to improve quality; elevating the patient experience of care; turning FFS into fee-for-value; and providing well-being and caring for caregivers. He also recommends utilizing data to improve quality, implementing a platform outside of an electronic health record (EHR) for population-based care, and integrating behavioral health resources, social workers, and psychologists into its primary care practices.
RevCycle Intelligence: (9/26) – Even as healthcare providers have operated in an unstable industry for the past few years and health care practices have been experiencing high rates of physician burnout since the pandemic hit, ACO programs have continued to achieve shared savings and promote the shift to value-based care. The transition from FFS to value-based care is a clear path to help alleviate the tensions that create physician burnout by putting more emphasis on coordinated and preventive care, allowing physicians to drive higher quality and connect with their patients on a more personal level.
Politico: (9/26) – This article highlights four consequential trends that will affect health care’s future and their potential benefits and downsides: at-home care, value-based care, primary care, and artificial intelligence. The author highlights that while value-based care encourages routine primary and preventive care, adoption is slow because of the expense to upgrade computer systems to collect patient data, shifting rules and incentives on how providers are paid and reluctance to move from a simple payment model to one that presents more financial risk. Primary care disruption has the potential to benefit patients, although the Federal Trade Commission has concerns about the power big firms are accumulating, and expanded telehealth could create fraud risks.
MedCity News: (9/25) – Aledade said that its value-based care network has helped save the U.S. healthcare system save more than $1.2 billion over the past eight years. Over 65 percent of practices in the network are located in areas that have been federally designated as having a shortage of primary care health professionals. Dr. Lee Fleischer, a primary care physician at an ACO that works with Aledade, testified that being a part of the network has yielded significant shared savings that have led to better care outcomes, such as lower re-hospitalization rates.
RevCycle Intelligence: (9/22) – A recent study from the Physician-Led Healthcare of America (PHA) found that physician-led hospitals improve care quality and lower patient costs by driving market competition. In 2020, only 4 percent of areas with physician-led hospitals were classified as very highly concentrated compared to 13 percent without physician-led hospitals. Further, almost 60 percent of physician-led hospitals had lower Medicare costs per beneficiary than the national median hospital in 2022, compared to 51 percent of all hospitals, generating $217 million in annual cost savings for Medicare. Physician-led hospitals also received higher patient experience ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), indicating better care quality.
Washington Monthly: (9/21) – This article highlights Big Med, a book by David Dranove and Lawton R. Burns, which offers an exhaustive analysis of the consolidation of U.S. hospitals and the effect it has had on both the cost and quality of health care. While Big Med offers few solutions, the author of this article notes that current dynamics, including labor shortages and the rising cost of labor, has led some hospitals to become open to considering a different model of payment and states that moving away from FFS and paying hospitals a “global budget” to care for patients would encourage greater efficiency and better care.
Health Leaders: (9/21) – This article answers questions around managing value-based care in a discussion with LaVonna Bowman, Director of Product Innovation at Inovalon. Ms. Bowman notes the importance of clearly defined value-based care contract goals, tracking engagement efforts toward meeting goals, and technology and data to measure performance and create transparency between health plans and physicians.
RevCycle Intelligence: (9/21) – This article highlights a new Families USA paper which states that high hospital prices are “bleeding Americans dry” as these organizations become more corporatized and put profits over patients. The report calls for reforms to create a more competitive health care industry to make care more affordable and recommends establishing a hospital global budget payment model and cost containment commissions so hospitals are held accountable for cutting costs and improving population health outcomes.