News Clips
Modern Healthcare: Physicians leaving private practice hurt patient care: survey (12/5) – Nearly 60 percent of physicians said the trend toward employment has reduced patient care quality, largely due to a lack of clinical autonomy and an increased focus on cost savings by facility leadership, said Kelly Kenney, CEO of the nonprofit institute. “Physicians feel very strongly about keeping their autonomy, their ability to make the best clinical decisions for their patients,” Kenney said. “So when there are policies in place that put corporate bottom lines first, that can really run up against the oaths that they took.” Around half of survey respondents said practice protocols or incentives have led them to adjust a patient’s treatment options to reduce costs.
Med City News: How Rising Value-Based Care Tides Can (But Don’t Necessarily) Lift All Patients (12/4) – As providers look to find more stability as they pivot into value-based care waters, they need to be conscious of the partnerships they forge on this journey. Done correctly, the right collaborative approach can have significant positive downstream impacts for all of a practice’s patients – even the ones not currently in a value-based care plan. Successfully navigating the value-based care landscape requires adopting new operational processes, workflows, and more. To enable this conversion, two leading methods have emerged. The first delivers interventions but is less collaborative and inclusive than the second option, which transparently partners with physicians.
Medical Economics: Can hospital ADT notifications change the game for value-based care? One Aledade case study shows what is possible (12/4) – Physicians have shared stories over the years about how a simple alert sent by a hospital to the right medical practice, at the right time, letting the physician know the patient had been treated in the hospital, changed the course of their patient’s outcome. These notifications are a key tool in both improving care and earning significant value-based care savings. This is the power of admit, discharge, and transfer (ADT) notifications, real-time alerts from hospitals to a patient’s physicians and care coordinators. As primary care practices continue to evolve, leveraging ADT notifications is one of the simpler ways to shift to a value-based care future. As seen with Aledade, real-time updates enable care teams to orchestrate seamless transitions between care settings, fostering continuity and coordination in patient care. This continuity not only improves patient satisfaction, but also contributes substantially to better health outcomes.
New York Times: Why Doctors and Pharmacists Are in Revolt (12/3) – The reasons for the recent labor actions appear straightforward. Doctors, nurses and pharmacists said they were being asked to do more as staffing dwindles, leading to exhaustion and anxiety about putting patients at risk. Many said that they were stretched to the limit after the pandemic began, and that their work demands never fully subsided. For years, many doctors and pharmacists believed they stood largely outside the traditional management-labor hierarchy. Now, they feel smothered by it. The result is a growing worker consciousness among people who haven’t always exhibited one — a sense that they are subordinates constantly at odds with their overseers. Dr. Wust looked back on his days in an independent practice of about 25 doctors with a similar wistfulness. “We were all partners,” he said. “It was relative workplace democracy. Everybody got a vote. Everybody’s concerns were heard.” Over time, however, consolidation and the rise of ever-larger health care corporations left workers with less influence.
STAT: Senate Republicans throw cold water on so-called site-neutral hospital pay cuts (12/1) – On its face, a minor policy to make sure Medicare pays hospitals the same as physician offices to administer medications has broad, bipartisan support from think tanks, stakeholders, and academics. But Republicans in the House and Senate are divided over the issue, creating a major obstacle to passage anytime soon. House Republicans had hoped to use a small cut to hospitals’ Medicare payments to help finance a raft of health policy that’s set to expire in January. But the policy has been stagnant in the Senate, where Republicans aren’t necessarily on board yet, senators told STAT. If the Senate truly can’t get on board with the “site-neutral” pay policy, that increases the chances that lawmakers will instead look to so-called PBM reforms to pay for the programs. Even Republicans who are usually moderate on health care issues aren’t necessarily on board with site-neutral payments, with some citing concerns about rural hospital solvency.
KFF News: FTC Chief Gears Up for a Showdown With Private Equity (11/30) – A recent Federal Trade Commission civil lawsuit accusing one of the nation’s largest anesthesiology groups of monopolistic practices that sharply drove up prices is a warning to private equity investors that could temper their big push to snap up physician groups. The large and growing volume of private equity acquisitions of physician groups in recent years has raised mounting concerns about the impact on health costs, quality of care, and providers’ clinical autonomy. A JAMA Internal Medicine study published last year found that prices charged by anesthesiology groups increased 26 percent after they were acquired by private equity firms. Now we’re seeing that scrutiny with this suit,” said Ambar La Forgia, an assistant professor of business management at the University of California-Berkeley, who co-authored the JAMA article. “This suit will cause companies to be more careful not to create too much local market power.”
Medical Economics: The Physician Crisis (11/30) – House Resolution (HR) 2474 is the Strengthening Medicare for Patients and Providers Act. It would provide physicians with Medicare payment updates adjusted for inflation as reflected in the Medicare Economic Index. “This would simply put physicians on equal footing as inpatient and outpatient hospitals, skilled nursing facilities and others who receive payment through Medicare,” Ehrenfeld said. Accounting for inflation, Medicare reimbursement to physicians is down 26 percent from 2001, AMA President Jesse M. Ehrenfeld said. Ehrenfeld highlighted a number of reasons why physicians hang up their white coats. Not least are administrative burdens, continuing attacks on science, governmental intrusion in health care, consolidation among health care systems and insurers and epidemic levels of gun violence and drug overdose deaths.
New York Times: Op-ed by Amol Navathe | Why Are Nonprofit Hospitals Focused More on Dollars Than Patients? (11/30) – Over the past year, a new hospital strategy has come to the fore, the cross-market merger. In the past, most mergers and acquisitions involved hospitals or physician groups in the same geographic area. Now health care systems are reaching far and wide to find other hospitals to acquire. We are witnessing the advent of the new American mega-hospital system. Calling these hospitals nonprofits can be confusing. It doesn’t mean they can’t make money. These hospitals proliferated after federal tax rules about 50 years ago made it easier to qualify for tax exemptions. They now make up more than half of the nation’s hospitals.
RecCycle Intelligence: Medicare Hospice Model Improved Quality of Life, Reduced Medicare Spending (11/29) – The Medicare Care Choices Model (MCCM) improved end-of-life care, increased hospice use, and reduced inpatient admissions for Medicare beneficiaries while simultaneously lowering Medicare spending, a study published in Health Affairs found. Beneficiaries can receive palliative care through the Medicare hospice benefit, but when choosing that route, they must waive the right to Medicare payment for non-hospice services that treat their terminal condition. Due to this policy, beneficiaries who want to continue conventional treatment of their illness may postpone or avoid hospice enrollment. Hospice and palliative care have been shown to improve care satisfaction and quality of life for terminally ill beneficiaries and their caregivers.
Becker's Hospital Review: Healthcare payment models are evolving: 5 key capabilities providers need to ace the shift to value-based care (11/29) – Based on experience working with hundreds of thousands of providers who serve about a quarter of the U.S. patient population, athenahealth has identified five foundational capabilities that help practices succeed with value-based care: patient identification; care coordination across a fragmented health care ecosystem; well-timed care delivery; patient engagement; and measurement.
Real Clear Politics: Lowering Healthcare Costs Through Site-Neutral Policies (11/28) – Medicare bases their reimbursement amount on the “type” of provider, but that many of these off-campus hospital outpatient departments (HOPDs) look more like a regular doctor’s office. So, when a patient receives medical services from a facility owned by a hospital, Medicare reimburses at a higher rate than if the service was provided at a private practice. This dual reimbursement rate creates an unintended incentive: If a hospital can buy a private medical practice, it will be considered part of its outpatient department, and Medicare will pay higher reimbursement rates than its physician-owned competitors. Consolidation within the health care industry is a sad consequence of these policies. A report to Congress on Medicare found that "in recent years, the number of services billed in HOPDs (Hospital Outpatient Departments) has been increasing, while the number of services provided in freestanding offices has been declining.”
Med City News: A New Deal for Hospitals (11/28) – The CMS Innovation Center has evangelized “value-based care” to reduce unnecessary health care spending. The latest generation of value-oriented payment models align rewards to total-cost-of-care management: incentivizing health care providers to keep people healthy and penalizing them for unnecessary, expensive interventions – like preventable hospitalizations. However, when hospitals adopt value-based payment models, they generally perform worse than physician groups engaged in comparable efforts, undoubtedly because their traditional revenue streams are the very costs value-based models prioritize reducing. Value-based care is the best policy we have to control costs. And its scope and impact are growing. Hospitals are therefore left without a viable choice: if they pursue value-based payment structures without embracing more comprehensive internal changes, they will trade dollars of utilization for cents in savings returns, harming their bottom line. If they reject value-based models, they will cede revenue to more efficient entrants, also harming their bottom line.
Politico: No one’s promising you can keep your doctor anymore (11/26) – Affluent people will be able to retain a personal physician through exclusive “concierge medicine” services. But here’s what others can expect: routine visits with a rotating cast of nurses and physician assistants with increasingly spare and online checkups with doctors. That changing calculus has Congress and the Biden administration busy trying to devise a primary care system that can serve the average person before it becomes impossible to get an appointment. “You’re not going to go back to the old days,” Senate HELP Committee Chair Sanders (I-VT) said in an interview. Both Republicans and Democrats agree the old way is no longer feasible — and they’re helping to speed its demise.
|