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.
HHS: (5/23) – United States Surgeon General Dr. Murthy issued a new Surgeon General’s Advisory highlighting the urgent need to address the health worker burnout crisis across the country. Health workers, including physicians, nurses, community and public health workers, nurse aides, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading to crisis levels of burnout. Health Worker Burnout
CMS Innovation Center: (5/23) – CMS announced the Year Seven results of the Independence at Home Demonstration, which found reduced expenditures by approximately 18% below spending targets for participating beneficiaries in 2020. All 10 practices taking part in the demonstration earned incentive payments. Year 7 Results
Rep. Watson-Coleman (D-NJ): (5/19) – Reps. Watson-Coleman (D-NJ), Katko (R-NY) and Butterfield (D-NC) introduced the Minority Fellowship Reauthorization Act of 2022 (H.R.7857), which would reauthorize the Minority Fellowship Program.
Sen. Scott (R-SC): (5/19) – Sens. Scott (R-SC), Casey (D-PA), and Cassidy (R-LA) introduced the Advancing Integration in Medicare and Medicaid (AIM) Act (S.4264), which would require States to develop a strategy to integrate and coordinate Medicaid and Medicare coverage for full-benefit dual eligible individuals.
Sen. Casey (D-PA): (5/19) – Sen. Casey (D-PA) introduced the Supporting States in Integrating Medicare and Medicaid Act (S.4273), which would provide States with resources to support efforts to integrate or coordinate Medicare and Medicaid benefits for individuals that are eligible for both programs. One-pager
Sen. Rosen (D-NV): (5/17) – Sens. Rosen (D-NV) and Boozman (R-AR) introduced the Physicians for Underserved Areas Act (S.4234), which would make improvements to the redistribution of residency slots under the Medicare program after a hospital closes.
RevCycle Intelligence: (5/24) – The Medical Group Management Association (MGMA) has asked CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process for determining an out-of-network payment rate for a surprise medical bill. CMS launched the online portal in April 2022 to create a space where healthcare providers and payers can initiate the IDR process within four days after the 30-day negotiation period.
STAT News: (5/18) – Parts of the Medicare Advantage program are ripe for reform, former and current top Medicare officials said.“We’ve literally created a nonproductive industry where there are businesses that collect diagnoses on Medicare Advantage solely for the purpose of getting paid — not to improve the care that these folks receive, but to improve the payment that the plans receive,” said Sean Cavanaugh, of Aledade and the top Medicare official at the Centers for Medicare & Medicaid Services during the Obama administration.
JAMA Network: (5/23) – Medicare has long provided two options for health coverage: a fee-for-service option (traditional Medicare) and a private plan option (Medicare Advantage). Enrollment in Medicare Advantage has increased rapidly, and in April 2022 accounted for an estimated 29 million individuals, representing 46 percent of all beneficiaries of Medicare. Accordingly, it is likely that Medicare Advantage will be the dominant source of Medicare coverage by 2025. This development creates significant challenges for the Medicare program and some important issues for the larger health care system.
Healthcare Dive: (5/23) – Widespread burnout among the healthcare workforce exacerbated by the COVID-19 pandemic is a major concern that needs to be urgently addressed, according to an advisory from U.S. Surgeon General Murthy. Burnout is contributing to ongoing staffing shortages, and the responsibility of eliminating factors that contribute to burnout falls primarily on healthcare employers, according to the advisory. Systems should address burnout systemically, and a priority is seeking and responding better to feedback from front-line workers. Healthcare employers should also get rid of policies that discourage staff from getting mental health and substance use disorder treatment, the advisory recommends.
Home Health Care News: (5/23) – Many home health care providers and Medicare-for-all advocates are against direct contracting in traditional Medicare. “ACO reach is not the same thing as Medicare Advantage. In fact, in my opinion, it is Medicare Advantage on steroids,” Rick Timmins, an active member of the Puget Sound Advocates for Retirement Action (PSARA), said on a virtual event. “But it is not the same as traditional Medicare either, especially when you follow the money. I learned my lesson the hard way. And if Wall Street firms are allowed to make decisions about your health care, their profits will always come first. Your health care will come second.”
MedCityNews: (5/20) – At the end of 2021, the CMS Innovation Center released a strategy refresh to transform the delivery system, focus on equity, pay for healthcare based on value to the patient instead of volume of services provided, and deliver person-centered care that meets people where they are. An important tool for this journey is the continued use of AI technology and machine learning in the healthcare system. Thanks to HIPAA, we now have the opportunity to leverage patient data in a way that advances value-based care. If they’re not already, healthcare companies need to begin training their AI technology with the CMS Innovation Center’s long-term goals in mind to continually educate and activate patients.
EHR Intelligence: (5/20) – Health information exchanges (HIEs) are well-situated to help healthcare organizations achieve the triple aim of value-based care—improving population health management strategies, providing better care for individuals, and reducing healthcare costs. Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for efficiency and effectiveness.
Healthcare Finance News: (5/19) – Interoperability in healthcare, it would seem, is at an important inflection point. Rules around data exchange have been around for years and regulate what patient information gets shared between payers, providers and the patients themselves. There are also standards around how that information is shared and the forms it can take. But the transition to value-based care has caused a shift in terms of the standards that apply to the data exchange, and new rules and technology mean there's less chance for redundancy, administrative waste and roadblocks to patient access.
Modern Healthcare: (5/18) – Accountable care organization participants aren't convinced the new ACO REACH health equity benchmark adjustment is going to move the needle and enhance care for beneficiaries in underserved communities. ACO industry watchers agree the policy is a good start, but many believe regulators will have more success driving health equity if they adopt an adjustment that isn't budget-neutral and alter how the adjustment is calculated.
Fierce Healthcare: (5/18) – State cost growth benchmarking programs can leverage data collection to advance preventive services like primary and behavioral healthcare. So argues the latest Manatt state cost containment update, now in its third iteration. States are increasingly interested in curbing cost growth and redirecting the way dollars are spent to services that support long-term population health, the report said.
MedCityNews: (5/17) – Over the past two years, we’ve seen API requirements apply to providers, hospitals, and other entities across the healthcare system for the first time. Newly un-siloed records are giving risk-bearing groups the chance to grab nearly real-time longitudinal data on their populations. With this information, any provider can find and get ahead of their most at-risk patients by calculating better risk scores, finding gaps of care, or just getting the most recent lab result on the patient. The end result is treating sicker patients early…with less resources… which is a win-win.