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.
PEPC and several of our members are pleased to be supporting organizations of Health Care Value Week 2023, which will take place next week, January 23-27, 2023. This year's agenda includes an exciting lineup of CMS and CMMI speakers and a number of other stakeholders, as well as a session on "Barriers and Opportunities for Independent Physicians in Value-Based Care" featuring Anders GIlberg, MGMA Senior Vice President of Government Affairs and Kristen McGovern, PEPC Executive Director. If you haven’t already, you can register here. Value Week is offered as a free event for registrants. You won’t want to miss it!
CMS: (1/17) – CMS announced enrollment in the Medicare Shared Savings Program (MSSP), ACO REACH model, and the Kidney Care Choices (KCC) Model for 2023. More than 700,000 health care providers and organizations will participate in at least one of the three initiatives, serving more than 13.2 million Medicare beneficiaries, in 2023. Additionally, CMS released participant information in the ACO REACH and KCC models. MSSP Fact SheetACO REACH Model ParticipantsKCC Model Participants
Healthcare Providers’ Safety Act of 2023: (1/11) – Rep. Escobar (D-TX) and 107 cosponsors introduced Healthcare Providers’ Safety Act of 2023 (H.R. 286), which would authorize grants to health care providers to enhance the physical and cyber security of their facilities, personnel, and patients. Bill Text
Aledade: (1/13) – Aledade released a blog post, “Policy Update: Health Care Policy Forecast for 2023,” highlighting policy changes that will lead to growth in MSSP in 2024 and physician fee schedule payments set for 2024. “Early indications are Congress may be interested in revisiting MACRA for a longer-term solution. The urgency will largely depend on whether inflation goes down in 2023 or continues to be high. If inflation continues to tick down, an expensive MACRA fix would be unlikely to make it through a divided Congress.”
American Academy of Family Physicians: (1/13) – American Academy of Family Physicians (AAFP) released a statement with five other physician organizations urging comprehensive Medicare payment reform. “On behalf of the nearly 600,000 physicians and medical students our organizations represent, we strongly urge the 118th Congress to address outdated Medicare physician payment so that patients can access the high-quality care they deserve, and physicians have the resources and flexibility they need.” The statement also applauds several health provisions included in the omnibus, such as investments in Medicare’s Graduate Medical Education program.
Fierce Healthcare: CMS: More providers serving as ACOs in 2023 amid new reforms and scrutiny (1/17) – The number of providers serving as accountable care organizations increased slightly this year thanks to the start of a new advanced model and a slew of reforms meant to reverse a slide in participation. CMS released participation data Tuesday for accountable care organizations (ACOs) serving Medicare patients this year across several programs. Overall, ACOs will serve more than 13 million Medicare beneficiaries. This year, there are 456 ACOs serving 10.9 million beneficiaries in MSSP, the most popular option available to providers. There are also 132 ACOs serving 2.1 million people in the ACO REACH model, which began its first performance period this year. Those figures are a slight improvement overall compared with 2022. Last year, MSSP had 483 ACOs serving 11 million people and ACO REACH, then known as Direct Contracting, had 99.
Modern Healthcare: Data shows mental health, primary-care physician shortage (1/17) – The number of medical residents pursuing careers in primary care and mental health has increased in recent years, but there still aren't enough specialists to meet the current demand. Labor shortages throughout the health care industry have led to delays in care and strained hospital resources. Hospitals and health systems as well as federal and state governments have tried to attract more into the profession, but there is concern that the growing number of physicians entering the field still won't be enough to keep up with rising demand and a wave of retirees. There were 14,193 residents—a 15 percent increase over the past three years—training in Accreditation Council for Graduate Medical Education-accredited family medicine programs in the 2021-22 school year, while the current shortage exceeds 17,000 primary-care physicians across U.S. health care professional service areas.
Healthcare Innovation: Change, Opportunities, and Threats: Our State of the Industry Survey (1/17) – In our annual State of the Industry Survey, we asked survey participants to respond to a wide range of questions around infrastructure, analytics, HIE, analytics, value-based contracting, cybersecurity, and several other topics. When it comes to one of the key areas of interest for senior leaders health care system-wide—participation in value-based contracting—we found a range of responses from participants, who represent senior leaders in hospitals, medical groups, and integrated health systems nationwide. Asked which types of value-based contracts their organization is involved in, the following were the results: MSSP: 31.82 percent; Next Generation ACO Program: 18.18 percent; Medicaid ACO: 25 percent; Private health insurer ACO or contract: 31.82 percent; Medicare Direct Contracting Program (now ACO REACH): 13.64 percent; and none of the above: 27.27 percent.
Healthcare Innovation: Going Into 2023, Leaders Look At Risk-Based Contracting and See Peril and Promise (1/17) – Health care leaders are examining the landscape and considering whether, how, and to what extent, to move forward into value-based contracting, including, importantly, risk-based contracting. Indeed, though hundreds of patient care organizations continue to participate in MSSP and the ACO REACH Program (formerly the Direct Contracting ACO Program), two programs for accountable care organization development sponsored by CMS under the Medicare program, and commercial health plans continue to sponsor ACO programs, and the Medicare Advantage program continues forward, questions remain at the moment as to whether health systems that prior to the pandemic had not advanced significantly into risk-based contracting, will move forward significantly now.
Forbes: U.S. Healthcare: A Conglomerate Of Monopolies (1/16) – De facto monopolies abound in almost every health care sector: Hospitals and health systems, drug and device manufacturers, and doctors backed by private equity. The result is that U.S. health care has become a conglomerate of monopolies. For two decades, this intense concentration of power has inflicted harm on patients, communities and the health of the nation. For most of the 21st century, medical costs have risen faster than overall inflation, America’s life expectancy (and overall health) has stagnated, and the pace of innovation has slowed to a crawl. This article, the first in a series about the ominous and omnipresent monopolies of health care, focuses on how merged hospitals and powerful health systems have raised the price, lowered the quality and decreased the convenience of American medicine.
RevCycle Intelligence: Healthcare Mergers and Acquisitions Regain Momentum (1/16) – Health care merger and acquisition (M&A) activity has regained momentum, ending 2022 with 53 announced transactions and more than $45 billion in total transacted revenue, reports Kaufman Hall. The latest analysis
of health care transactions shows a rebound in M&A activity after COVID-19 dampened enthusiasm over the last couple of years. The total number of health care transactions remains below pre-pandemic levels, but there are clear signs that the momentum will continue into 2023, the firm says. The analysis notes that these four transactions are also representative of cross-market deals, marking another significant trend in 2022. These organizations have little or no overlap between markets, indicating “capability-based scale is much more prominent than adjacent market-based scale.”
Commonwealth Fund: State Strategies for Controlling Health Care Costs: Implementation Guides (1/12) – The rapidly increasing cost of health care is burdening families, businesses, and government. In recent years, state policymakers have undertaken a range of activities to address health care costs, from establishing per capita growth targets to increasing transparency around pharmacy costs and addressing market consolidation. Unlike the prevalent fee-for-service models, value-based payment is a health care purchasing strategy that can hold health care providers accountable for the quality and cost of care they deliver to patients. There are many possible models, including hospital global budgeting, episode-based payment, and total-cost-of-care contracting.
EHR Intelligence: Physicians in ACOs More Likely to Use HIE to Share Patient Data (1/12) – Physicians in emerging care models, such as ACOs, were significantly more likely to use health information exchange (HIE) to share patient data than physicians in traditional care delivery models, according to a study published in AJMC. Additionally, the researchers found nuances in relationships between emerging practice models and HIE use based on practice type. Group and hospital-based practices primarily drove the positive relationships between emerging practice model participation and HIE use. “Our study provides new evidence that HIE barriers specific to small practices and community clinics may manifest even in emerging practice models such as ACOs and integrated care models,” the authors noted.
Health Leaders: Rising Outpatient Surgery Volumes Offer Opportunity For Value-Based Care Models, Study Finds (1/11) – Inpatient surgery utilization levels decreased 7.33 percent from 2019 to 2021, according to a survey of over 12 million commercial insurance members by Cedar Gate Technologies. The research found that hospital outpatient surgery volume grew by 3.1 percent. However, the largest increase was in ambulatory surgical centers, with utilization rates rising by 10.26 percent. "Experts increasingly agree that hospital inpatient surgery volume is unlikely to ever go back to pre-pandemic levels. Increases in outpatient and ASC surgical volumes, however, present an opportunity for value-based care delivery models by providing strong patient outcomes and lower costs."
Healthcare Dive: Doctors no longer bound by noncompetes under FTC’s proposed ban (1/11) – The Federal Trade Commission’s (FTC) proposed ban on noncompete clauses in employment contracts is poised to dramatically alter the health care sector, which frequently relies on restrictive covenants to retain physicians and the patients they treat. The FTC’s sweeping proposal would free physicians to work for a competitor, undermining the status quo in physician-employer relationships, health care attorneys told Healthcare Dive. The FTC focused on several occupations in its draft rule, including physicians. The agency said as many as 45 percent of primary care physicians were bound to a noncompete, according to a prior study. The same study found that noncompete clauses were associated with higher earnings than those without the restriction.
Medpage Today: The million dollar mistake: Why medical schools don’t teach business and how it’s costing physicians (1/11) – The fact that every physician in private medical practice, without a business education, leaves approximately a million dollars on the table and is unaware of it is well known to business experts who work with medical doctors experiencing financial difficulties. Business experts understand the financial problems faced by medical practices and how to solve them. It is astounding that all medical schools in the United States have never required or offered a business education for admission or to prepare medical students and doctors for starting or maintaining the profitability of a medical practice. Why are physicians excluded from this education?