News Clips
Lebanon Reporter: OPINION: Healthcare concentration is far from what the doctor ordered (11/8) – Independent doctors are vanishing. Hospitals and corporations acquired more than 36,000 physician practices between 2019 and 2021. Last year, roughly three in four doctors were employed by a hospital or larger corporate entity like a health insurer - a 19 percent increase from 2019. One consequence of all these mergers is less patient choice. When one health system takes over an entire region, patients essentially have to receive care in its affiliated hospitals and clinics. One study found that hospital prices go up more than six percent when one merges with or acquires another in the same geographic region. Some experts put the average price increase at nearly 20 percent.
Washington Post: Drowning in patient emails, doctors start charging for their replies (11/4) – A 2021 study in the Journal of the American Medical Informatics Association found that messages to doctors in patient portals increased by 157 percent between early 2020 and late 2021. And national data through mid-2022 show that the rates have stayed that high or even slightly increased, the study authors say. Many say they want to connect with patients — they just don’t want to do it every night in their pajamas. Physician Jack Resneck, chairman of dermatology at UCSF and the immediate past president of the American Medical Association, says “sometimes in health-care things get turned on without a plan for how we are going to build this into our workday and how are we going to compensate for the time and … how will physicians … have protected time.” Resneck says he often answers patient emails after putting his children to bed.
Medical Economics: National reforms needed to avoid ‘many small, independent practices in a state of financial ruin’ (11/4) – Primary care is undervalued and overburdened across the United States, but there are measures that could help, said the leader of the AAFP. Steven Furr, MD, FAAFP, the academy’s president, offered his solutions this month in testimony presented to the House Committee on Energy & Commerce. “Primary care physicians consistently report that they are being asked to do more with less – and it’s having a profound impact on our health care workforce and on patient access,” he said in his written testimony.
American Medical Association: Nearly 60% of doctors work in a practice that’s part of an ACO (10/30) – Physician participation in ACOs has grown steadily since 2014, even as fee for service (FFS) remains the most prevalent payment method and revenue generated by alternative payment models has stagnated, according to the results of an AMA survey of about 3,500 physicians. Participation in ACOs has seen similar growth, with 57.8 percent of physicians surveyed saying that their practice belonged to at least one type of ACO in 2022, compared with 44 percent in 2016. FFS remains the most common payment method with 86.4 percent of physicians reporting that their practice received a portion of their revenue that way in 2022. The report says 64.3 percent of physicians were in a practice that received revenue from an alternative payment method in 2022, which is down from 66.8 percent in 2020.
RevCycle Intelligence: Value-Based Reimbursement Grows as Providers Take on More Risk (10/30) – Over half of health care payments last year were made through value-based reimbursement models, with most of those payments tied to some degree of financial risk, according to the latest data from the Health Care Payment & Learning Action Network (LAN). This year’s “APM Measurement Effort” found that just 40.6 percent of payments across public and private payers were strictly FFS. Meanwhile, 18.1 percent of payments had some link to quality and value. Slightly more payments this year were tied to more meaningful value-based care efforts, with 31.7 percent of payments from alternative payment models (APMs) with upside-only or upside and downside financial risk for appropriate care and 9.6 percent from population-based payment arrangements, such as condition-specific and comprehensive population-based payments, as well as payments from integrated finance and delivery systems.
Modern Healthcare: AMA, allies plead for leniency as Medicare pay penalties loom (10/30) – Physician groups are pressuring CMS to forestall looming penalties associated with the Merit-based Incentive Payment System (MIPS), citing systemic challenges facing doctors and the ongoing effects of the COVID-19 pandemic. "When you adjust for inflation, the payment rate to physicians who care for Medicare patients has dropped 26 percent since 2001," AMA President Dr. Jesse Ehrenfeld said at a news conference in Washington Wednesday. "I don't know many businesses in any industry that could withstand a 26 percent drop in revenue and still survive," said Ehrenfeld, an anesthesiologist who practices in Milwaukee and is a professor at the Medical College of Wisconsin. Small and independent medical offices, especially in rural and other underserved areas, are most vulnerable, Ehrenfeld said in a statement Thursday. "With their tight operating margins, these practices simply cannot sustain a combined double-digit payment cut on top of the rising costs of practice," he said.
AHEAD Model: The AHEAD Model And The Potential To Advance Equity Through Population-Based Care (10/30) – AHEAD continues recent trends in payment model policy, seeking to improve health outcomes, advance equity, and address health care spending. Its features include enhanced primary care investment, requiring explicit health equity implementation plans, and care redesign in a total-cost-of-care framework. The model recognizes the need for coordination across the care continuum, the impact of both medical and non-medical drivers of health, and the role of community-based services. Yet AHEAD also stands apart as a population-based model. It is designed at a state— rather than care delivery organization—level, with a policy goal of collaboration between federal and state governments and provision of supports for “participating states through various … components that aim to increase investment in primary care, provide financial stability for hospitals, and support beneficiary connection to community resources.” As a population-based model, AHEAD includes a number of positive elements in its proposed equity strategy. The ability to achieve its goal of addressing disparities will depend in part on implementation and consideration of other equity-oriented strategies.
Modern Healthcare: AMA pushes Medicare pay hikes bill (10/26) – Congress should support the Strengthening Medicare for Patients and Providers Act of 2023, Dr. Jesse Ehrenfeld, president of the American Medical Association, said at a news conference in Washington on Wednesday. “For the last 20 years, a shrinking Medicare reimbursement rate for physicians has pushed many small, independent practices to the brink of financial collapse and jeopardized care for millions of America’s seniors,” Ehrenfeld said. Adjusted for inflation, physician payments have declined 26 percent since 2001, he said. The legislation would update the Medicare physician fee schedule to account for inflation in annual payment updates. Rep. Dr. Raul Ruiz (D-Calif.) introduced the measure in April, but it has just 54 cosponsors, has not received committee consideration in the Republican-controlled House and does not have a Senate companion bill.
Fierce Healthcare: New multispecialty advocacy group wants to protect independent practices from hospitals' buyouts (10/26) – A new national, multispecialty advocacy organization representing independent practices launched last week. The American Independent Medical Practice Association (AIMPA) says it is the first advocacy organization of its kind focused on supporting private medicine across specialties. It is made up of 5,000 physicians collectively treating 10 million U.S. patients and includes specialties ranging from cardiology to gastroenterology to medical oncology to OB-GYN and more. The group does not yet include a primary care doc, though AIMPA executives said they would welcome the opportunity to work with them. AIMPA's formation comes amid growing consolidation in the health care sector. Between 2012 and 2022, the share of physicians working in private practices fell by 13 percentage points from 60 percent to 47 percent, according to one estimate.
STAT: The health care issue Democrats can’t solve: hospital reform (10/26) – Democrats unilaterally drove major reforms to the health insurance and the pharmaceutical industries without a single Republican vote in recent years. But hospitals may be a health care giant they’re unable to confront alone. Unlike Republicans, Democrats have seized on lowering health care costs as a politically winning issue in one election cycle after another. They have campaigned on passing health insurance reform, and then protecting it. And after 20 years, they finally delivered on a promise to empower the federal government to lower drug prices in 2022. But the remaining elephant in the room is hospital costs, which make up the biggest share of U.S. health care spending. And Democratic leaders in Congress have shown this year that they are unable to agree on even the most incremental steps toward addressing the cost of hospital care. While hospitals haven’t traditionally faced the same public antipathy directed toward large pharmaceutical companies, medical debt is a massive health care affordability issue that Congress has been slow to address.
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