News Clips
The Heritage Foundation: (10/5) – The lack of competition in the nation’s hospital markets undermines patient choice and increases consumers’ costs. Robert Moffit argues that to foster competition in hospital markets, Congress should: encourage state officials to review, reform, or repeal certificate of need laws; include site neutrality in Medicare payment; and repeal the ACA restrictions on Medicare payment to physician-owned hospitals and specialty hospitals.
Chicago Booth Review: (10/4) – Under US antitrust law, companies must notify the federal government of their plans to merge or buy other companies—but only in large deals. Smaller transactions that fall below legal thresholds are exempt from the notification reporting requirement. In the dialysis industry, two multinational providers built empires through years and years of small deals that largely passed unnoticed by antitrust enforcement agencies.
Fierce Healthcare: (10/1) – Physician and hospital groups are slamming the Biden administration’s latest surprise billing rule, charging that it unfairly tilts a dispute process over out-of-network charges in insurers’ favor. The administration’s interim final rule details how to handle disputes between payers and providers over out-of-network charges. But providers chafed at the rule’s direction for independent arbiters to rely on a benchmark rate to settle disputes.
Fierce Healthcare: (9/30) – CMS Chief Operating Officer Jon Blum said to not expect a lot more fully risk-based payment models from CMMI during the National Association of Accountable Care Organizations' fall conference. Although Blum said it is still important to have risk-based models, there is data that show downsides of full-risk payment models. “We know that when we [incentivize] risk we see some downsides to that,” Blum said. “We see stronger incentives for more diagnosis code submissions, some of which might be appropriate, some of which not.”
STAT News: (9/30) –The article’s authors, Brian J. Miller and Jesse Ehrenfeld, argue for a reversal of the decision that prevents physicians from operating hospitals and billing Medicare. They write that this decision has had a profound impact on competition in hospital markets.
Health Affairs: (9/30) – In Part Two of their Health Affairs piece, Richard Gilfillan and Donald M. Berwick wrote that the best way to mitigate the undesirable effects of Direct Contracting would be to stop the program. Ideally, CMS should announce that the Direct Contracting Model will be replaced in 2023 by a new Medicare Shared Savings Program (MSSP) model that uses CMMI authority to create more advanced tracks for providers, including full capitation.
Health Affairs: (9/29) – In Part One of their Health Affairs piece, Richard Gilfillan and Donald M. Berwick wrote about the increase in financing and acquisitions of firms focused on serving Medicare beneficiaries. They argue that the perverse MA business model is what underlies this elevated level of investment. Gilfilllan and Berwick say this business model is distorting health care delivery, creating excessive costs for taxpayers and Medicare beneficiaries, draining the Medicare Trust Fund, obstructing the badly needed value transformation of American health care, and diverting the money needed to fund other social services and goods.
Healthcare Dive: (9/29) – U.S. health insurance markets have become increasingly concentrated over the past half decade, according to a new report from the American Medical Association, which argues payer M&A results in rising costs and fewer care options for patients, but largely excludes the impact of provider consolidation in driving those trends. Almost three-fourths of metropolitan statistical areas were highly concentrated in 2020 according to federal guidelines used by the Department of Justice and Federal Trade Commission, up from 71 percent in 2014.
Fierce Healthcare: (9/29) – The National Association of ACOs (NAACOS) released a white paper Wednesday that outlines a series of recommendations to better position organizations to help address health equity, a key priority for the Biden administration. These recommendations include calling on the Biden administration to provide more money upfront to help form accountable care organizations in rural areas and give more financial support to address health equity.
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