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News Clips
Modern Healthcare (12/4) What to expect in the primary care market in 2030 – Faster growth is predicted for companies that offer supportive technology and administrative services to value-based care providers. "Value-based care is going to continue to expand and more physicians are going to either want to participate or just by the economics of their practices feel like they need to be," Ney said. "The operational, administrative and financial hurdles to being successful in value-based care arrangements is very real and these enablers offer a path to independent physicians who otherwise may not have the financial need or the administrative operational know-how to feel like they are capable of successfully taking on risk."
National Conference of State Legislatures (11/15) 2024 Legislative Recap: Health Care Consolidation and Competition – Research from the American Medical Association suggests health system consolidation is rising nationwide, prompting state policymakers to examine its impact on costs and quality of care. This includes horizontal consolidation, i.e., between the same types of organizations like hospitals, and vertical consolidation, i.e., across different types of providers, like hospitals acquiring physician practices. A growing body of research indicates that consolidation leads to higher prices, though research on its impact on quality are mixed. Some providers maintain consolidation can enhance access to care and is essential for some rural providers and facilities to remain viable. At least 34 bills relating to health system consolidation and competition were enacted across 22 states in 2024. These policies included oversight of health system mergers and acquisitions, health system contracting reforms, modifying certificate of need review, and more.
Arnold Ventures (11/15) Medicare Already Pays 2 – 4x More for the Same Care — and the Gap is Growing – For years large hospitals have been buying up independent physician practices, changing the name on the door and charging more for the same services. Medicare pays more for care in many hospital-owned clinics than in an independent physician’s office, and that gap continues to grow, further incentivizing care to shift to higher cost settings. A new brief from Actuarial Research Corporation quantifies the magnitude of the payment differential between hospital-owned clinics and physician offices and how quickly it is growing. These concerning trends emphasize the urgent need for Congress to act to protect patients from higher costs for routine care. Without Congressional action on site-neutral payments, the Medicare payment differential between hospital outpatient departments (HOPDs) and a physician’s office will continue to rapidly widen, creating stronger financial incentives to consolidate. Patients already pay two to four times more for the same routine care at a hospital outpatient department than a physician’s office, and that difference is growing at about four percent a year, nearly double the rate of medical inflation.
Healthcare Finance (11/13) NAACOS pushes ACO REACH extension after $1.54B in savings – Accountable Care Organizations in the Centers for Medicare and Medicaid Services' ACO Reach program achieved $1.54 billion in gross savings and $694.6 million in net savings in 2023, CMS has announced. The National Association of ACOs (NAACOS) has responded by advocating for an extension of the federal program. Net savings to ACOs were $948.4 million (3.4 percent) compared to model benchmarks – an increase from the $371.5 million in net savings to CMS and the $484.1 million in net savings to ACOs in plan year (PY) 2022. Savings increases from PY 2022 are due to performance improvements by model participants as they gained experience and growth, CMS said. Between 2022 and 2023, per beneficiary per month gross savings increased by 72 percent to $71.15.
Heritage Foundation (11/7) Medicare Physician Payment: The Case for Market-Based Reforms – Almost annually, physicians face the prospect of Medicare payment cuts unless Congress intervenes to block or modify them. Without congressional intervention, such cuts would affect patients directly in the form of less access to care and services. The current system of physicians’ reimbursements has been a source of ongoing concern for doctors and other health care providers and is ripe for reform. Physicians who serve Medicare patients practice under a payment system that is the product of decades of government price controls, a history of fixes and starts, and piecemeal and patchwork adjustments to flawed administrative pricing arrangements. Congressional leaders should re-examine the shortcomings of previous payment reform efforts and craft a new path forward. It is past time for bold solutions that will properly realign incentives and ensure that older Americans have access to the best care that physicians can provide at a sustainable cost.
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