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This Week in Physician-Led Care

December 9 to December 15 2020

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. 

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Administrative Updates

CMS: (12/15) - CMS released an FAQ document on the Community Health Access and Rural Transformation (CHART) Model to provide additional information and details on various participatory and financial components of the CHART Community Transformation Transformation Track.

HHS: (12/10) - HHS issued a Notice of Proposed Rulemaking (NPRM) to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The proposed changes seek to support individuals’ engagement in their care, remove barriers to coordinated care, and reduce regulatory burdens on the health care industry.

HHS: (12/10) - HHS issued 340B Drug Pricing Program: Administrative Dispute Resolution rule. The final rule sets forth the requirements and procedures for the 340B Program’s administrative dispute resolution (ADR) process. The final rule goes into effect on January 13th, 2021.

CMS: (12/10) - CMS issued the Interoperability and Patient Access proposed rule, which would place new requirements on Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of health care data, and streamline processes related to prior authorization.

CMS: (12/10) - CMS released a proposed rule to reduce provider and patient burden by improving prior authorization processes and requiring patient access to certain health information. The rule builds on the previously-finalized CMS Interoperability and Patient Access rule, and creates new requirements for Medicaid FFS, Medicaid MCOs, CHIP FFS, CHIP MCOs, and QHPs on the FFE.

CMS: (12/9) - CMS announced that optional letters of intent (LOIs) for the Community Transformation Track for the Community Health Access and Rural Transformation (CHART) Model are due by January 12, 2021.

HHS: (12/7) - HHS issued a brief that identifies technological, organizational and environmental facilitators of and barriers to integrating data into workflows to support value-based care. The brief notes that integrating data from outside sources such as provider notes, diagnostic imaging, ADT alerts, discharge summaries and care plans could help support key care coordination activities. A key gap includes limited research documenting what data integration currently looks like on the ground.

Legislative Updates

Sen. Manchin: (12/14) - A bipartisan group of Senators introduced two COVID-19 emergency relief bills totaling $908 billion. The Bipartisan COVID-19 Emergency Relief Act of 2020, would provide $748 billion in relief for American students, families, business, and health care providers, including $35 billion for the provider relief fund. The Bipartisan State and Local Support and Small Business Protection Act would provide $160 billion in funding for state and local governments and liability protections. The Problem Solvers Caucus is working on a version of the package for the House.

Sen. Boozman: (12/10) - Sens. Boozman (R-AR), Hyde-Smith (R-MS), Cramer (R-ND), Cotton (R-AR), and Collins (R-ME) introduced the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 (S. 5007), which would provide for an increase in payment under Part B of the Medicare program for certain services in response to COVID-19.

Rep. Walorski: (12/8) - The House passed by voice vote the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act of 2019 (H.R. 2477), which would establish a system to notify individuals approaching Medicare eligibility and would simplify and modernize the eligibility enrollment process. The bill now moves to the Senate for consideration.

Rep. Wenstrup: (12/7) - Reps. Wenstrup (R-OH) and Sewell (D-AL) introduced the Rural-Urban Physician Workforce Act of 2020 (H.R. 8892), which would support rural residency training funding and promote partnerships with urban teaching hospitals.

Member News

Medpage Today: (12/11) - Last week, HHS announced a proposed rule to modify the privacy provisions of HIPAA. In response to the notice of proposed rulemaking, MGMA questioned if the rule will impose reasonable requirements on medical practices that avoid costly administrative burdens, noting that they look forward to providing detailed feedback on the rule.

News Clips

AJMC: (12/15) - A recent study by the American Journal of Managed Care measured the variation in spending and inpatient prices associated with the primary care physician practice to which patients are attributed. The study found that physician practices account for significant variation in spending, reflecting variation in utilization and price of care delivered by practices, and provides recommendations for how to reduce spending.

Fierce Healthcare: (12/15) - Startup Papa Health, which was created to offer assistance and address loneliness for older adults, is launching a new platform to expand into virtual primary care and chronic care management. The service aims to improve health outcomes for older adults and help facilitate medical care in the home, especially during the pandemic.

Healthcare Dive: (12/14) - Members of Congress reached an agreement on surprise billing on Friday, which could be included in a year-end appropriations bill expected this week. The approach proposed would settle disputes between health plans and providers through an independent arbitration process, an approach that has been favored by providers.

Fierce Healthcare: (12/14) - The COVID-19 pandemic has made the case for why the fee-for-service model is unsustainable, marking the need for a shift in how health care is funded and delivered moving forward. As such, 2021 has the potential to be a landmark year for more widespread adoption of value-based care across the health care system.

Healthcare Dive: (12/11) - The Trump Administration released a proposed rule that would ease a number of standards established in the HIPAA privacy law. The proposed rule would remove certain barriers to value-based care, including allowing plans and providers to use health data more broadly to improve care coordination and case management of individual patients.

Revcycle Intelligence: (12/10) - A group of bipartisan policymakers unveiled a $908 billion COVID-19 relief bill, which included several provisions to support health care providers. The Bipartisan Emergency COVID Relief Act of 2020 would add $35 billion to the Provider Relief Fund (PRF), $7 billion of which would be directed toward rural health providers and $1 billion of which would be directed toward the Indian Health Service. The bill would also change PRF reporting requirements and allow health systems to move targeted distributions within their system.

Fierce Healthcare: (12/10) - Humana unveiled its plans to expand its use of the CMS Primary Care First model to qualified primary care providers across 48 states and D.C. who are in-network for its Medicare Advantage PPO and HMO plans. Humana will offer participating providers a monthly prospective capitation payment under the model, which could be helpful for providing consistent revenue streams for providers whose finances have been impacted by the pandemic.

Fierce Healthcare: (12/10) - Elation Health, which provides a clinical technology platform for independent primary care practices, pivoted quickly to support independent practices during the COVID-19 pandemic. The company integrated telehealth capabilities into its platform to assist independent practices with conducting virtual care visits, which helped mitigate overall declines in practice visits with a decrease of only 30 percent during the pandemic.

Health Affairs: (12/9) - A recent study by Health Affairs found that lower-income adults in the United States fare relatively worse on measures of affordability and access to primary care compared to those in ten other high-income countries.The study found that low-income adults in the US were less likely to have a regular provider or place of care, and were more likely to skip necessary care visits or follow-ups due to cost.



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