News Clips
The Hill: US kidney care is broken. But we have the means to fix it – op-ed by Alex Azar (3/4)
– Unfortunately, our kidney care system remains broken, leading to massive human and financial cost implications. For too long, the pay-for-service model of health care has persisted with a lack of innovation or change. We must as a country align provider incentives to reward prevention and early detection. In other words, if you want more transplantation then pay more for transplantation, and if you want a reduction in chronic kidney disease (CKD) progression then reward a reduction in CKD progression. An effective alternative to the outdated and counterproductive fee-for-service system has emerged. Value-based care aligns incentives with patient outcomes in a pay-for-performance arrangement, improving the quality and delivery of care while driving costs out of the system.
NBC News: How hospitals are fighting to keep their former doctors from seeing patients (3/4)
–While employers say noncompete agreements are necessary to protect the investment they make in recruiting, marketing and supporting their doctors, physicians argue the provisions can harm patients by restricting access to care and risk discouraging doctors from speaking out about unsafe or unethical conditions. “We have seen these noncompetes increase exponentially over the last several years, and it really goes against the very ethos of medicine,” said Omar Atiq, president of the American College of Physicians. “It takes a while for physicians to start really knowing their patient, not just the disease for which they come but the patient themselves, and to just sever that relationship is a big blow.” President Joe Biden pledged in his State of the Union address in 2023 to ban noncompetes across the economy, and the FTC is on track to make a final decision about a proposed ban early this year, said a Biden administration official.
Health Affairs: Private Equity–Acquired Physician Practices And Market Penetration Increased Substantially, 2012–21 (3/4) – Private equity firms continue to acquire physician groups at an increasingly fast clip, prompting closer scrutiny from state and federal lawmakers. Private equity acquisitions of physician practices grew seven-fold between 2012 and 2021, according to a new study. A single private equity firm controlled a majority of one or more specialties across 50 markets, researchers found. Some of the most concentrated markets were in the South and Northeast, including the Dallas-Fort Worth area and around Baltimore, Maryland.
Med City News: Preserving the Pillars: The Vital Role of Independent Primary Care in American Healthcare (3/3)
– Independent primary care physicians and practices have been the foundation of the American health care system for decades. Moving forward they are as critical to the health of our system as ever, and it is our collective responsibility to ensure they continue to thrive and are in a position to do the best work for their patients. As the cornerstone of our health care system, primary care physicians play a pivotal role in managing the entire scope of care for patients of all ages and backgrounds. Primary care doctors, in conjunction with their care teams, offer a spectrum of medical services, ranging from routine check-ups and preventive care to chronic disease management and post-acute support. What sets independent primary care groups apart from larger health care entities is the unwavering commitment to patient welfare and outcomes over achievement of financial gains. This patient-first philosophy creates the ideal environment for fostering enduring trust-based doctor-patient relationships, which are the foundation of high-quality, cost-effective health care.
RevCycle Intelligence: Consumer Advocacy Orgs Share How to Move Away From Fee-For-Service Payment (3/1) – As health care spending rises, shifting away from fee-for-service payment and delivery models that incentivize volume over value is imperative. Families USA and other consumer advocacy groups are urging policymakers to implement reforms that improve health care affordability and quality and support the transition to value-based care. Families USA, American Heart Association, National Consumers League, National Partnerships for Women and Families, and Third Way penned the Pro-Consumer Policy Agenda to Achieve Meaningful Health System Transformation. The organizations presented six pro-consumer policy principles that would alter economic incentives to hold health care systems accountable for care quality and costs.
Health Affairs: Enabling Better Integration For Dually Eligible Participants In Medicare Value-Based Care Models (3/1) – Since the implementation of the ACA, a major shift has been underway in how individuals in traditional Medicare receive their services. CMS has been systematically developing programs that focus on providing value-based care to these enrollees. These programs include the Medicare Shared Savings Program (MSSP); ACO REACH; Making Care Primary; and more. CMS has a stated goal of having 100 percent of traditional Medicare beneficiaries in these programs by 2030. The existing D-SNP model presents a template for how states could begin to create integrated environments for their dually eligible individuals in Medicare value-based care models. Similar to the D-SNP model, Medicare value-based care models would be required to regularly sign a State Medicaid Agency Contract (SMAC) with the states in which they operate. SMACs for Medicare value-based care programs would ensure that these programs coordinate with Medicaid on everything from benefit design to models of care.
RevCycle Intelligence: How Can Providers Establish Successful Accountable Care Organizations? (2/29) – Accountable care organizations (ACOs) are a common way health care providers can transition from fee-for-service to value-based care delivery. In ACOs, providers come together to deliver quality coordinated care to patients while usually taking on some of the financial risk. Providers must have the right mindset to care for patients and the capabilities to support their goals to establish a successful ACO, according to Rachit Thariani, chief administrative officer for the Ohio State University Wexner Medical Center’s post-acute and home-based care division.
Healthcare Innovation: Advocacy Organization President: Private Practice Is Becoming a Niche (2/27)
– A new physician-led national advocacy organization seeks to empower independent medical practices during major consolidation among hospitals and payers. “You see independent medical practices basically becoming insolvent or throwing up a white flag and saying we can't keep our doors open anymore; we can't make any revenue. The problem is accelerating. Private practice in this country is going to become a niche, and physicians will have fewer employment options. Patients are going to have fewer choices of who to go to. They're going to go to physicians employed by big hospital systems or big corporations, and we don't feel that that's a good trajectory. We think that independent practitioners deliver high-quality care to our communities. We've been here forever, and we're not going anywhere. We want to make sure that some of those factors that are not contributing to a level playing field are addressed.”
Commonwealth Fund: Federally Qualified Health Centers Can Make the Switch to Value-Based Payment, But Need Assistance (2/26)
– FQHCs have a unique financing structure that relies on federal grant funding and low Medicaid reimbursements. As a result, they operate on thin, often unpredictable financial margins, which limits their ability to implement and sustain improvements. Value-based payment (VBP) models could help. Under VBP arrangements, payment is tied to the quality, cost, and equity of care rather than the volume of services delivered. Providers are often given an upfront lump sum for each patient, giving them greater flexibility to deliver the right care at the right time.
RevCycle Intelligence: Making ACOs More Accessible for Long-Term and Post-Acute Care Providers (2/26) – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of ACOs (NAACOS) have released recommendations on how to increase accountable care organization (ACO) participation among long-term and post-acute care (LTPAC) providers. LTPAC providers face barriers to participating in ACOs due to misaligned program policies, such as those that determine which patients ACOs are accountable and those that set financial benchmarks and quality measures. The financial methodology should be adjusted in ACOs so the reference population includes a similar rate of institutionalized patients, the stakeholders said. CMS should also use the concurrent risk adjustment model that is being tested in ACO REACH for the SNF population.
STAT: Congress ditches site-neutral hospital pay policy (2/26) – Congress will not move forward with a controversial policy to equalize certain Medicare payments to hospitals and physicians’ offices in an upcoming government funding package, five lobbyists and sources following the talks told STAT. The delay is a win for hospitals, which have adamantly lobbied against the policy. It would have seen Medicare paying one price to doctors who administered drugs, whether they did so in an office or at a hospital, rather than paying more in the latter scenario. A House-passed version of so-called “site-neutral” payments would have saved the federal government billions of dollars. But Senate Republicans have voiced concerns about how such a policy could impact rural hospitals in their districts.
Clinical Pathways: How to Support the Adoption and Integration of Specialty Value-Based Care Models: A Conversation Across Multiple Stakeholders (2/21) – Outcomes Matter Innovations, a group that focuses on supporting specialists engaging in value-based care models, hosted a Healthcare Innovations Summit (the Summit) in Aspen, Colorado, over two days in February 2023. The Summit brought together stakeholders from across the health care continuum to discuss the barriers to implementing value-based care models for specialty care, and what can be done to overcome them and integrate the models with primary care. Attendees included providers; payers (both Center for Medicare and Medicaid Innovation [CMMI] and commercial payers); biotech; pharma, tech, and clinical start-up organizations; investors; and legal experts. This article discusses the broad spectrum of perspectives that were presented at the Summit, all of which focused on the move toward comprehensive and collaborative care for patients requiring specialty care.
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