Welcome to this week's edition of the The Partnership to Empower Physician-Led Care weekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians.
CMS: (5/6) - CMS announced the agency has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19. Effective today, the national average payment rate will increase from $310 to $450 for most health care settings. In support of providers’ efforts to prevent the spread of COVID-19, CMS will also establish a higher national payment rate of $750 when monoclonal antibodies are administered in the beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging.
HHS: (5/6) - HHS Secretary Becerra announced that nearly 940,000 Americans have signed up for health insurance through HealthCare.gov as a result of the Biden Administration’s Special Enrollment Period (SEP) for the COVID-19 Public Health Emergency.CMS Fact sheet
CMS: (5/5) - CMS announced that the release date for the Maryland Primary Care Program request for applications (RFA) will be spring 2022. Additional information will be shared when available.The Maryland Total Cost of Care (TCOC) Model sets the state of Maryland on course to save Medicare over $1 billion by the end of 2023, and the Model creates new opportunities for a range of non-hospital health care providers to participate in this test to limit Medicare spending across an entire state.
GAO: (5/5) - The U.S. Government Accountability Office (GAO) issued an analysis on use of funding for COVID-19 relief, showing that through March 2021, VA had committed to spending $9.9 billion and spent $8.1 billion of this funding. Much of the committed funding went to veterans' health care from non-VA providers, additional salary costs (such as for overtime), and to help homeless veterans. GAO notes that the VA plans to use its remaining funding on testing, equipment, distributing vaccines, and more.
HHS: (5/5) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report on disparities in COVID-19 vaccination rates across racial and ethnic minority groups. HHS found that across all reporting states, a lower proportion of the Black and Hispanic populations have been vaccinated compared to the non-Hispanic White population. HHS also reported that vaccine accessibility issues, including challenges with vaccine scheduling, transportation and other concerns, likely contribute to lower vaccination rates in Black and Hispanic populations.
HHS: (5/5) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report identifying factors that have influenced variation between states in efficiency of COVID-19 vaccine administration. HHS found although various factors have been hypothesized to drive the observed variation in administration rates, no clear patterns emerged when evaluating data from all 50 states and the District of Columbia. Importantly, expanding eligibility criteria to a larger proportion of the population was not significantly related to higher administration rates, though when vaccine supply is limited, is associated with lower coverage of the highest priority populations.
Aledade: (5/11) - Aledade released its Road Map for Primary Care: Making the Shift to Value-Based Care resource to help practices learn how to develop an action plan to transition from fee-for-service to value-based care and why patient prioritization and preventative care are key to success.
Revcycle Intelligence: (5/10) - In a recent special report, MGMA outlines insights from health care leaders on how practices can rebuild to pre-pandemic patient volumes and revenues through staffing stability, patient engagement, and telehealth. Among findings in the report included that while specialist physicians saw the steepest decrease in compensation at the onset of the pandemic, primary care providers also saw steep compensation drops in March and April 2020, but telehealth expansion helped to restore volumes and compensation in the spring.
California Medical Association: (5/10) - The California Medical Association (CMA) is urging the Biden Administration to take action to support increased participation in COVID-19 vaccine distribution by community providers, including independent and small physician practices. In a recent fact sheet, CMA outlines actions to increase participation by such practices, including creating a system to distribute small dose order distribution for pediatric and adult providers, streamlining the CDC application process for all providers, and increasing financial assistance for providers to provide support for workflow changes and time spent attempting to participate.
Healthcare Dive: (5/11) - Stakeholders in the health care industry have grown frustrated with the lack of clear information around what remains in the Provider Relief Fund and how and when those remaining funds will be available to providers. Some providers have not yet received funds for the fall and winter months, when several practices were hit hard by surges in COVID cases and faced significant losses. According to HRSA, about $24 billion in funds remain in the Provider Relief Fund as of May 5, in addition to the $8.5 billion allocated to rural providers by the American Rescue Plan. Providers, however, still feel left in the dark.
Modern Healthcare: (5/7) - To reduce vaccine hesitancy, health care stakeholders say that increasing access to COVID vaccines in primary and outpatient care settings could make a difference. Primary care offices in particular serve as a regular source of care for many individuals compared to the mass vaccination sites that were highly utilized at the start of the vaccine rollout. As demand for the vaccine decreases, primary care physicians can play an important role in speaking to their patients about the vaccine and being trusted partners in patient care.
Modern Healthcare: (5/6) - According to two recent analyses, having an effective public option with lower premiums would mean cuts to provider rates would be likely, as it is considered a main way to reduce premium costs. A Brookings Institute analysis acknowledged that a public option could be harmful to providers in rural areas or other vulnerable settings that have to choose between harming patient care and cutting costs. A separate brief by the Center for American Progress found that lowering provider rates would be a key element of success for a public option, but maintained that payment rates for rural and safety-net providers, community health centers, and others should still be sufficient.
Revcycle Intelligence: (5/6) - According to a recent analysis by the American Medical Association, more providers are beginning to shift away from private practice and toward hospital-owned practices in recent years. The analysis found that 49 percent of AMA physicians worked in physician-owned practices by 2020, down from 54 percent in 2018.
JAMA Health Forum: (5/6) - Given the recent transition to a new administration and a decade of models coming through CMMI, now is the opportune time to assess the path forward for alternative payment models (APMs). This article proposes a new approach to testing APMs compared to the approach CMMI has taken over the last 10 years of developing and testing several models, outlining the need to recognize the overlap and interactions among models and move to a portfolio paradigm in which a set of complementary models is offered to meet policy goals.
JD Supra: (5/6) - In the second of a five-part series discussing value-based care regulations, this article outlines the concept of creating a value-based enterprise to satisfy requirements in regulations adopted by CMS last year - a Stark value-based exception and Anti-Kickback statute value-based safe harbor. The goal of such an enterprise is to increase efficiencies in the delivery of care and improve outcomes for that patient population.
NEJM: (5/5) - As vaccine rates have plateaued and declined in some places in recent weeks, many are beginning to grow concerned about COVID vaccine hesitancy and how not involving primary care practices in the process could further hinder progress and undermine equity in the vaccine rollout. This article suggests that ready access to vaccines at usual sources of care may be critical in reaching those who are receptive or neutral toward receiving the vaccine, and that primary care clinicians and trusted health care organizations have working relationships with community leaders and have earned trust with patients to address this issue at the local level.
Modern Healthcare: (5/5) - Several studies have recently been published outlining how health care costs and low-value care typically increase when independent or small physician practices are acquired by hospital systems. While vertical integration can facilitate more coordinated care, evidence has shown it can also lead to increased costs due to shifts in referral patterns and more low-value care. A study of primary care doctors in Massachusetts who transitioned to hospital-owned employment, for example, found that the odds of a patient receiving an inappropriate MRI scan for back, knee or shoulder pain increased over 20 percent after an independent practice physician transitioned to hospital employment.
Modern Healthcare: (5/5) - The American Medical Association released its Physician Practice Benchmark Survey, finding that the number of physicians working in physician-owned practices fell below 50 percent for the first time. This drop has corresponded with a rise in employment by hospitals, health insurers, and private equity firms. For example, 40 percent of physicians worked for hospitals or practices at least partially owned by hospitals in 2020, up from 29 percent in 2012. This often varied by age and specialty, but has also been a result of the economic impacts of COVID-19.
MedPage Today: (5/5) - Last week, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a report outlining an evidence-based plan with objectives and recommendations for implementing high-quality primary care in the US. The report listed five steps that should be taken to do so, including: 1) pay for primary care teams to care for people, not doctors to deliver services; 2) ensure that high quality primary care is available to every individual and family in every community; 3) train primary care teams where people live and work; 4) design information technology that serves the patient, family, and interprofessional care team; and 5) ensure that high quality primary care is implemented in the US.
American Hospital Association: (5/5) - The American Hospital Association (AHA) sent a letter to HHS Secretary Xavier Becerra urging him to extend the deadline for providers to use COVID-19 Provider Relief Fund payments, which is now set for June 30. The AHA asked Secretary Becerra to extend this deadline to the end of the public health emergency, given the expenses providers continue to face related to COVID and the need to apply Provider Relief Fund funding toward personal protective equipment, maintaining testing, and other services.
Revcycle Intelligence: (5/4) - Vertical integration has significantly increased in the health care market in recent years, leading to higher costs. A recent Health Affairs study found that vertical integration increased referrals to hospitals and increased Medicare spending as a result, for example. A separate Health Affairs study found that hospital employment of physicians in Massachusetts was associated with inappropriate diagnostic care.