News Clips
Fierce Healthcare (10/1) New analysis points to troubling trends as U.S. healthcare costs rise, but health outcomes worsen – Trilliant Health's report
outlines eight macro trends influencing the health care industry including health care costs and health status trends, health care utilization, value-based care policies, technology innovation, the impact of GLP-1s and artificial intelligence. Since its establishment by the Affordable Care Act in 2010, CMMI has tested numerous value-based care models, including ACOs, disease-specific models, episode-based models and prescription drug models. These initiatives have involved over 314,000 providers and served more than 41.5 million Medicare and Medicaid beneficiaries. Trilliant Health's analysis shows that there has been limited reductions in spending or improvements in quality.
KFF (10/1) One or Two Health Systems Controlled the Entire Market for Inpatient Hospital Care in Nearly Half of Metropolitan Areas in 2022 – This analysis examines the competitiveness of markets for hospital care, based on RAND Hospital Data—a cleaned and processed version of cost reports from Medicare-certified hospitals—and American Hospital Association (AHA) survey data. One or two health systems controlled the entire market for inpatient hospital care in nearly half (47 percent) of metropolitan areas in 2022. In more than four of five metropolitan areas (82 percent), one or two health systems controlled more than 75 percent of the market. Nearly all (97 percent of) metropolitan areas had highly concentrated markets for inpatient hospital care when applying HHI thresholds from antitrust guidelines to MSAs.
STAT (9/20) Hassan indicates she’s open to tweaks on site-neutral payment reforms – Sen. Hassan (D-N.H.) is pushing to reform Medicare payments to ensure the program pays the same amount for the same services, no matter where patients get care — and she might be willing to cut a deal with Republicans to do it. Hassan is the lead Democrat in the Senate pushing to equalize payments between hospitals and outpatient facilities. During a STAT event on Thursday, she indicated that there might be room for negotiating a deal with her GOP colleagues on site-neutral legislation. One of the hospital lobby’s talking points that has gained traction is that a move to equalize payments could hurt rural hospitals. It’s been echoed by Senate Republicans, and Sen. Cassidy (R-LA), who could be a key negotiator on site neutrality next year, said he thinks the policy would cut too much money from hospitals. “He and I are actually engaged with stakeholders right now around the site neutrality act,” Hassan said of Cassidy.
North Carolina Health News (9/23) When your doctor’s visit comes with a hospital fee — but no hospital – As big hospitals snap up physician groups and specialty clinics, more patients in North Carolina and across the country are getting hit with these types of surprise hospital facility fees, according to experts and federal reports. Hospital facility fees traditionally were added to hospital bills to help cover the higher overhead costs of operating a 24/7 hospital with expensive emergency rooms, intensive care units, round-the-clock maternity units and the like. But increasingly, health care systems are rebranding other types of medical buildings they own as “hospital outpatient facilities,” allowing them to tack on those same hospital fees for patient visits that are miles away from a hospital campus. In 2023, the N.C. Senate approved legislation as part of the “Medical Debt De-weaponization Act” that would have banned facility fees unless you received care on a hospital campus, at a remote hospital location or at a facility with an emergency department.
AJMC (9/22) CMMI's Latest Payment Models Address Health Disparities, but Challenges Remain – The federal government has been increasing efforts to tackle health care disparities by linking payment models with social determinants of health. In July, The Center for Medicare and Medicaid Innovation (CMMI) announced a new area-level ACO REACH measure for program year (PY) 2025, replacing the PY2024 blended national/state Area Deprivation Index (ADI). “As CMMI continues to test new equity adjustments, it is important that changes be grounded in scientific principles with extensive testing and validation to ensure the tightest linkage to social needs and health outcomes for underserved communities across the entire US,” the authors wrote. “Stakeholder input is important, but not all stakeholders have the same policy influence. Decisions based on smaller geographies or specific metropolitan areas in isolation of the entire nation should be avoided. A robust scientific framework could broadly inform policy across CMMI programs.”
Wall Street Journal (9/22) Doctors Organize to Push Back Against Private-Equity Takeovers – Private equity’s takeover of thousands of health care businesses has sparked a backlash among physicians, and many are joining new professional organizations to oppose corporate influence in U.S. medicine. Several of these groups are working with lawmakers to craft legislation to limit private equity’s influence in health care. Others aim to educate peers about private equity’s impact on their profession. These groups underscore a potential problem facing private-equity investors in the medical sector. Many doctors hold strikingly negative views of buyout firms and, increasingly, are taking political action against them. While most analyses focus on how private-equity ownership affects patients, it has also had a deep impact on physicians. This shift accelerated during the Covid pandemic, when private-equity investment rose and concentration increased as many doctors, struggling under financial and professional strains, sold their practices to larger groups. In 2022 and 2023, corporate entities such as private-equity firms acquired 5,300 physician practices, an 11 percent increase in just two years, according to the Physicians Advocacy Institute.
Health Affairs (9/20) Improvement Science And Value-Based Payment Models – This Forefront article considers a novel approach to building value-based payment models that emphasizes continuous revision during their implementation. Inspired by quality improvement models that have improved delivery system performance, the authors propose that iterative model development in payment may allow for a more flexible understanding of population-level risk, financial incentives that in turn promote better care delivery processes, and rapid iteration of delivery system activities to overcome inertia.
Modern Healthcare (9/20) Why private equity-linked sales of physician groups have slowed – Private equity firms are struggling to find buyers for physician groups in the wake of increased oversight and financial pressure. Rising interest rates, lower evaluations and tougher regulations have scuttled potential private equity-led physician group deals. Health care attorneys say a softening sellers’ market has irked doctors, many of whom were promised a pay boost once private equity-backed management services organizations flipped a physician practice to another buyer. More states, including Massachusetts, Rhode Island and Connecticut, also enacted laws requiring tougher oversight of private equity-linked health care transactions. For instance, the California legislature passed a bill last month that would require private equity groups and hedge funds to notify and obtain consent from Attorney General Rob Bonta (D) when those companies pursue transactions linked to health care. Gov. Gavin Newsom (D) has not signed the bill.
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