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: (5/25) - CMS announced that the Independence at Home Demonstration performance period is anticipated to end on December 31, 2023. Under this model, CMMI will work with medical practices to test the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions.
Modern Healthcare: (5/25) – The Senate confirmed Chiquita Brooks-LaSure to serve as the next CMS Administrator. Brooks-LaSure’s nomination was approved by a 55-44 vote, with four Republicans voting alongside Democrats to confirm her nomination.
HHS: (5/25) - HHS, through HRSA, announced that it is dedicating $4.8 billion from the American Rescue Plan to support the HRSA COVID-19 Uninsured Program. This funding will allow the program to continue reimbursing health care providers for testing uninsured individuals for COVID-19. As of May 19, 2021, the program has issued nearly $4 billion in testing reimbursements to providers.
HHS: (5/25) - HHS announced additional Biden Administration appointments to serve across HHS departments. These new appointees will join career officials throughout the agency, and will address the COVID-19 public health crisis, implementing the American Rescue Plan, ensuring Americans have access to quality and affordable health care, strengthening support for seniors and other vulnerable populations, conducting groundbreaking research, and more.
CMS: (5/24) - CMS posted the fourth annual report and associated materials for the Home Health Value-Based Purchasing (HHVBP) Model. The first four years of implementation of the HHVBP model have resulted in cumulative Medicare savings of $604.8 million, a 1.3 percent decline relative to the 41 non-HHVBP states, as well as improvements in quality. These impacts were observed during 2019, the second year for quality based payment adjustments, as well as the initial three years of the model. Findings at a glance
Inside Health Policy: (5/21) - CMS announced it will not extend the Next Generation Accountable Care Organization demonstrations beyond 2021. CMS will, however, allow participants of the model to join the Global and Professional Direct Contracting (GPDC) Model in 2022 despite previous announcements that it would not accept additional direct contracting applications for next year. In a recent announcement shared with NextGen ACOs, CMS said it is continuing to test high-risk financial arrangements and APMs under the direct contracting model, and that there would be value in leveraging the experience and operational capabilities of NextGen ACOs by offering them the opportunity to participate in the GPDC model.
HHS: (5/20) - HHS ASPE issued a report describing methods and findings of a project to identify existing health equity measurement approaches that might fit with Medicare’s value-based purchasing (VBP) programs, quality reporting efforts, and confidential reports. The report defined a “health equity measurement approach” and identified a set of guidelines for health equity measurement.
HHS: (5/20) - HHS announced $14.2 million from the American Rescue Plan to expand pediatric mental health care access by integrating telehealth services into pediatric primary care. The funding will expand Pediatric Mental Health Care Access (PMHCA) projects into new states and geographic areas nationwide, including tribal areas.
US Supreme Court: (5/19) - HHS is asking the Supreme Court to bypass a case brought on by hospital groups challenging site-neutral payment rates for certain outpatient evaluation and management (E/M) services, which the department lowered in 2019 to control “unnecessary” increases in volume. HHS wrote in a brief that the agency justifiably exercised its authority to eliminate a Medicare payment differential that incentivized unnecessary outpatient services.
GAO: (5/19) - The U.S. Government Accountability Office (GAO) issued a report of COVID-19 Medicare and Medicaid flexibilities and considerations for their continuation. The report also outlines preliminary observations from ongoing work related to telehealth waivers in both programs. GAO found that CMS issued over 200 Medicare waivers and more than 600 Medicaid waivers or flexibilities.
GAO: (5/17) - GAO issued a report on the Community Behavioral Health Clinics (CCBHC) demonstration. HHS's preliminary assessments of the demonstration in eight states, with 66 participating CCBHCs, found that CCBHCs improved access to mental and behavioral health including medication-assisted treatment. GAO also documents cost and quality findings and notes that data limitations complicated HHS’s efforts to assess the effectiveness of the demonstration.
Roll Call: (5/20) - At a recent Senate Health, Education, Labor and Pensions (HELP) Committee, Primary Health and Retirement Security Subcommittee hearing, Chair Bernie Sanders said the federal government could help boost the number of practicing physicians in the United States. The government spends about $16 billion every year to fund thousands of medical residency programs. Sen. Sanders suggested Congress could expand these programs, as well as programs to get doctors into medically underserved areas, and plans to introduce legislation to authorize 14,000 new Medicare-supported residency programs over seven years. The bill would establish new criteria about how the residency slots would be allocated, so half of these doctors would go into primary care.
Direct Primary Care Accessibility Act: (5/20) - Rep. Rosendale (R-MT) introduced the Direct Primary Care Accessibility Act (H.R.3436), which would exempt certain direct primary care arrangements from regulation as health insurance coverage.
Birth Access Benefiting Improved Essential Facility Services (BABIES) Act: (5/19) - Reps. Clark (D-MA), Herrera Beutler (R-WA), Roybal-Allard (D-CA) and Hinson (R-IA) introduced the Birth Access Benefiting Improved Essential Facility Services Act (BABIES) Act (H.R.3337), which would establish a Medicaid demonstration program to develop and advance innovative payment models for freestanding birth center services for women with a low-risk pregnancy. Sen. Lujan (D-NM) introduced companion legislation in the Senate (S.1716).
Midwives for Maximizing Optimal Maternity Services (MOMS) Act: (5/19) - Reps. Clark (D-MA), Herrera Beutler (R-WA), Roybal-Allard (D-CA) and Hinson (R-IA) introduced the Midwives for Maximizing Optimal Maternity Services (MOMS) Act (H.R.3352), which would address maternity care shortages and promote optimal maternity outcomes by expanding educational opportunities for midwives. Sen. Lujan and Sen. Murkowski introduced companion legislation in the Senate (S.1697). Summary
Sen. Klobuchar: (5/18) - The Senate Judiciary Committee, Subcommittee on Competition Policy, Antitrust, and Consumer Rights, recently held a hearing on hospital consolidation. Witnesses testified on concerns around hospital consolidation and possible solutions for Congress to consider.
RevCycle Intelligence: (5/17) - A bipartisan group of 77 Congress members, led by Reps. Cindy Axne (IA-03) and Mariannette Miller-Meeks (IA-02), released a letter on May 11th urging HHS to reconsider its June 30th deadline for spending unused grants from the Provider Relief Fund. In a recent press release, Rep. Axne said, “Our nation’s health care providers have been on the frontlines of the fight against COVID-19 for over a year, and we can ill afford to sever a financial lifeline when providers are still treating patients with COVID-19 and facing higher prices for things like PPE.”
Inside Health Policy: (5/24) - In addition to extending the deadline to spend provider relief funds past June 30, group medical practices are asking HHS to address what they consider unnecessarily complex and administratively burdensome financial reporting requirements that make providers submit all their health care expenses to prove they needed the relief. Claire Ernst, government affairs associate director at MGMA, said that HHS should clarify and simplify reporting requirements and guidance, as practices want to comply with them but often face administrative burden and confusion in doing so.
Fierce Healthcare: (5/21) - A new survey found that 81 percent of medical groups reported an increase in prior authorization requirements this year as the practice gets targeted by Congress. MGMAreleased a new survey that showed the impact of prior authorization requirements since last year. Anders Gilberg, senior vice president of governmental affairs at MGMA, said that medical practices have reported increased denials, delayed approvals for care, and constantly changing rules in addition to a rise in prior authorization requirements.
AAFP: (5/21) – In a recent blog, AAFP outlined the increasing role family physicians have started to play in COVID vaccine distribution. These providers have been vocal advocates in their local communities and are working to help address vaccine hesitancy that has resulted in slowed immunization rates. Practices are being creative in how they reach individuals, including a Maryland pilot program that used primary care practices to administer vaccinations resulting in delivering doses to over 35,000 people.
Florida Medical Association: (5/20) – In a recent brief, the Florida Medical Association outlined four looming Medicare reimbursement cuts that will take effect in 2022 without Congress intervention that providers should keep in mind. The brief provides an overview of the four key issues, and key considerations for providers.
mHealth Intelligence: (5/20) - The California Medical Association (CMA) is challenging Governor Gavin Newsom's proposal to reimburse audio-only telehealth services for Medi-Cal members at 65 percent of comparable in-person care. In a recent press release, CMA said it was “disheartened” by Newsom’s plan to reimburse for audio-only services at less than in-person rates for members of the state’s Medi-Cal program, given it has been a critical tool for expanding access to care and reducing health disparities during the pandemic. The provision is included in Newsom’s proposed 2021-2022 budget.
Aledade:(5/19) - Aledade CEO and co-founder Farzad Mostashari spoke with Jennifer Geeter, a partner at McDermott Will & Emery, for the very first episode of their "Trailblazing with Digital Health Pioneers” series. In this episode, Farzad and Jennifer discuss how independent primary care practices are leading the way in value-based care and how the digitization of health care has failed, yet also succeeded.
Radiology Business: (5/24) - The number of radiologists participating in Medicare accountable care organizations has surged in recent years, according to a new analysis. Radiologist participation in value-based care-coordination efforts increased threefold during the five years ending in 2018, from 10 percent up to nearly 35 percent. Participation rates grew faster for physicians in radiology-only rather than multi-specialty groups.
MedPage Today: (5/21) - Primary Care Physician Lucy McBride wrote an Op-Ed on the need for primary care. She writes that physician shortages, burnout, poor reimbursement, workload, and time constraints conspire to make the current healthcare situation untenable. The U.S. invests significantly in healthcare but only a limited amount of that overall investment goes towards primary care. Dr. McBride suggests that the low investment in primary health care may be partly to blame. She stresses the need to reimage health care delivery to meet both the mental and physical needs of patients.
New York Times: (5/21) - Large hospital chains received billions of dollars in COVID aid, even as they were buying up smaller hospitals and physician practices. More consolidation by several major hospital systems enhanced their market power in many regions of the United States, even as rural hospitals and underserved communities were overwhelmed with COVID patients and struggled to stay afloat. Senators are calling for increased scrutiny of how the COVID relief was used and the Biden administration is now weighing which hospitals and health providers will get the remaining $25 billion.
Modern Healthcare: (5/21) - CMS' Center for Medicaid and Medicare Innovation's decision to pause applications for the Global and Professional Direct Contracting (GPDC) Model could have important consequences for both the model and the future of value-based care. Some experts fear that canceling or pausing alternative payment models like the GPDC Model would cause health care executives to question the Biden Administration's commitment to value-based care and curb their investment in it. Providers may hesitate to invest in specific models since they might change or go away, which could undermine their success—and the transition to value-based care.
NAACOS: (5/21) - NAACOS released a press release in response to CMS’s decision to not extend the NextGen ACO model. In its statement, NAACOS expressed disappointment in the decision to deny the request to extend the model through next year, but appreciated the opportunity for NextGen ACOs to apply to the Direct Contracting model as it can be a viable path for continued participation in other accountable care models.
RevCycle Intelligence: (5/20) - A new survey by Merritt Hawkins reveals that new physician recruitment rates are falling. The survey found that, in 2020, 62 percent of final-year residents received 26 or more recruiting offers, dropping from 82 percent in 2019. However, the number of medical residents in the US increased by almost 5,000, which could indicate a positive trend for the future of the health care workforce amid a physician shortage.
Modern Healthcare: (5/19) - The Senate Judiciary Committee, Competition Policy, Antitrust and Consumer Rights subcommittee, held a hearing where policy experts offered a range of solutions to try to restore the competitive balance and prevent anti-competitive transactions in the health care market. They recommended strengthening the Federal Trade Commission and Department of Justice so they can review more transactions. Martin Gaynor, professor of economics and health policy at Carnegie Mellon University and one of the witnesses at the hearing, said that federal regulators should require reporting of small deals that fall under the current threshold, revise old policies that incentivize consolidation and market imbalance, and develop a national health care database on spending, utilization, prices and ownership models to address anti-competitive practices in health care.
Managed Healthcare Executive: (5/17) - In an interview with Managed Healthcare Executive, Dr. Vivian Lee of Verily Life Sciences addresses if value-based care programs have steered U.S health care away from the problems of fee-for-service. Lee also shares her thoughts on if the pandemic changed her views of American health care.
Health Affairs: (5/17) - The privately insured are paying more and more for health care because of the high and rising prices providers charge. Health care markets in the U.S. are becoming increasingly consolidated and the lack of competition allows providers to charge increasingly high rates for private insurance. Unlike in Medicare and Medicaid, insurers in the private insurance market must negotiate payment rates with providers. Dominant health systems can exert their market power in these negotiations to demand higher prices. The evidence is clear that provider consolidation and a lack of competition leads to higher prices for people with private insurance with little to no effect on the quality of care. As one solution, the authors of this blog recommend capping prices based on a percentage of Medicare rates, limiting what hospitals can charge to twice what Medicare pays.