Administrative Updates

CMS: (12/3) - CMS announced the new Geographic Direct Contracting Model (Geo), which will test whether a geographic-based approach to value-based care can improve quality of care and reduce costs for Medicare beneficiaries across an entire geographic region. Geo will be tested over a six-year period in four to ten regions and will include two three-year performance periods, the first of which starts on January 1, 2022 and the second of which starts on January 1, 2025. Fact sheet Information

Legislative Updates

Energy & Commerce Committee: (12/3) - House Energy & Commerce Committee Chair Pallone (D-NJ) was reelected as Chair of the Committee for the 117th Congress.

Ways & Means Committee: (12/3) - House Ways & Means Committee Chair Neal (D-MA) was reelected as Chair of the Committee for the 117th Congress.

Ways & Means Committee: (12/3) - House Ways & Means Committee Ranking Member Brady (R-TX) was reelected as Ranking Member of the Committee for the 117th Congress.

House Oversight & Reform Committee: (12/3) -House Oversight & Reform Committee Chair Maloney (D-NY) was reelected as Chair of the Committee for the 117th Congress. Press release

House Oversight & Reform Committee: (12/3) - House Oversight & Reform Committee Ranking Member Comer (R-KY) was reelected as Ranking Member of the Committee for the 117th Congress.

House Veterans’ Affairs Committee: (12/3) - Rep. Bost (R-IL) was selected to serve as Ranking Member of the House Veterans’ Affairs Committee for the 117th Congress.

Energy & Commerce Committee: (12/2)- Rep. McMorris Rodgers (R-WA) was selected by the Republican Steering Committee to serve as the next House Energy & Commerce Committee Ranking Member for the 117th Congress.

Rep. Brad Schneider: (12/2) - Reps. Schneider (D-IL), McKinley (R-WV), Schrier (D-WA), Suozzi (D-NY) and Rush (D-IL) introduced the Medicare Sequester COVID Moratorium Act (H.R. 8840), which would amend the Coronavirus Aid, Relief, and Economic Security Act to extend the temporary suspension of Medicare sequestration.

Sen. Cory Booker: (12/2) - Sen. Booker (D-NJ) introduced the Equality in Medicare and Medicaid Treatment Act (S. 4944), which would improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation.

Member News

Healthcare Dive: (12/4) - CMS unveiled the new Direct Contracting Model, or Geo this week. Travis Broome, SVO for Policy and Economics at Aledade commented that the model is ambitious because it will make organizations responsible for the health of people who don’t already have strong, established relationships with their providers.

Modern Healthcare: (12/3) - While CMS has added more than 60 services to the list of Medicare reimbursable telehealth services, Sean Cavanaugh, Chief Policy Officer and Chief Commercial Officer of Aledade notes that the greatest limitation on the expansion of telehealth is the originating site restrictions, which CMS does not have authority outside of the public health emergency to waive.

Medical Economics: (12/2) - In response to the CMS 2021 Physician Fee Schedule, MGMA said that while the streamlined documentation policies and payment increases to physicians that primarily deliver office/outpatient E/M services is a good step forward, the 10 percent decrease to the conversion factor and resulting reimbursement cuts to many specialties is deeply troubling during a time when COVID-19 cases are struggling and practices are scrambling to stay financially viable. Anders Gilberg, SVP of Government affairs noted that CMS should provide the stability that physician practices require to meet patient needs during this unprecedented time. 

AAFP: (12/1) - AAFP sent a letter to President-elect Joe Biden outlining key areas of emphasis for the Academy and primary care, including strengthening the primary care workforce, improving healthy equity, expanding value-based payment reforms, and continuing to use telehealth.

News Clips

Modern Healthcare: (12/7) - President-Elect Joe Biden announced Xavier Becerra as his nominee for HHS Secretary. While COVID-19 is expected to be the main focus in the first year of the Biden Administration, Becerra is expected to leverage regulation to limit provider consolidation and anticompetitive practices in the health care system. Experts believe he might also work with CMMI to develop new models to expand access and transparency for patients.

Financial News Media: (12/3) - Although hospital mergers and acquisitions (M&A) have decreased in 2020 due to COVID-19, industry executives expect to see a rise in M&A in 2021. A key factor observed in such activity is uncertainty around provider revenue, and the NIH has stated that the acquisition of physician practices will be difficult to reverse as a result of the current health care environment. This article outlines activity around M&A thus far in 2020 and what to expect in the year ahead.

MedCity News: (12/3) - Value-based contracting for prescription drugs could be a solution to addressing rising drug costs in the Medicaid program. Entering into such a contract would require pharmaceutical companies to take additional risk for improved patient outcomes from their medications, however not entering into such contracts could result in reduced or restricted access to that company’s medications.

STAT: (12/2) - In this op-ed, former CMO of the Medicaid program Andrey Ostrovsky outlined what the Biden Administration can do in its first 100 days to institute new, evidence-based policies to build a more resilient organization at CMS. Suggestions fell under the following four categories: reaffirm the vision of the Quadruple Aim, control COVID-19 and remedy the market failures that drive disparities, develop financial resilience through value-based payments, and reinvest in making CMS a learning organization.

Modern Healthcare: (12/2) - A report by the Primary Care Collaborative found that spending on primary care services in the commercial market dropped from 2017 to 2019, a sign that more needs to be done to invest in primary care services industry-wide. Spending for services rendered by physicians accounted for 4.67 percent of spending in 2019, dropping from 4.88 percent of spending in 2017. Primary care services rendered by physician assistants, nurse practitioners, and physicians accounted for 7.69 percent of spending in 2019, dropping from 7.8 percent in 2017.

Modern Healthcare: (12/2) - The CMS outpatient prospective payment system final rule, released last week, could help increase provider competition. The changes set forth in the rule could allow physician-owned hospitals to expand if they treat a large number of Medicaid patients, phase out inpatient-only procedures list, and continue 340B drug cuts.

Events

December

• December 9, Aledade, “Why You Should Join an ACO with Primary Care First and Considerations for CPC+ Practices.” Virtual.
• December 10, Modern Healthcare, “Webinar: Leveraging Lab Analytics for Success in Value-Based Care.” Virtual
• December 10, Modern Healthcare, “Webinar: Leveraging Lab Analytics for Success in Value-Based Care.” Virtual.
• December 10, California Medical Association, “Telehealth Series for Small and Medium Sized Practices: Telehealth Office Workflow.” Virtual.

If you would like your event to be included in the next newsletter, please email kristen@physiciansforvalue.org.