Welcome to 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.
PEPC: (4/19) – PEPC was pleased to submit a statement for the record for the House Energy and Commerce Committee Health Subcommittee hearing, “Lowering Unaffordable Costs: Legislative Solutions to Increase Transparency and Competition in Health Care.”
PEPC provided support and comments on proposed legislation pertaining to: site neutral payment policies; examining the impact on consolidation during the rulemaking process, as well as CMS Innovation Center model evaluations; and reforms to the inpatient only list.
PEPC highlighted additional areas where Congressional action is needed, including: physician payment reform, transparency and antitrust enforcement, and levering physician-led payment models.
CMS: (4/26) – CMS announced updates to enforcement processes for the Hospital Price Transparency Rule which are intended to increase compliance with the hospital price transparency requirements. CMS will begin imposing penalties earlier and automatically, as well as streamlining the compliance process.
Government Accountability Office: (4/26) – The Government Accountability Office (GAO) released a report on the Internal Revenue Service (IRS) oversight of nonprofit hospitals’ tax-exempt status. GAO recommends Congress consider specifying what services and activities demonstrate sufficient community benefit and that the IRS update tax forms to increase transparency about hospitals' community benefits. Slightly more than half of the approximately 5,000 community hospitals in the U.S. are private, nonprofit organizations.
John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act: (4/26) – Sens. Booker (D-NJ), Padilla (D-CA), and Brown (D-OH) re-introduced the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, legislation that would require the CMS Innovation Center to work with experts to consider health disparities when developing payment models. Rep. Sewell (D-AL) introduced companion legislation in the House. Bill Text
AAFP, MGMA: (4/26) – The American Academy for Family Physicians (AAFP) and Medical Group Management Association (MGMA) sent a letter to Reps. DelBene (D-WA) and Duncan (R-SC) expressing support for the Chronic Care Management Improvement Act of 2023, which would remove patient cost-sharing obligations from the Chronic Care Management (CCM) code, to ensure that more chronically ill Medicare patients receive access to high-quality care.
Axios: North Carolina bill would carve UNC hospitals out of antitrust laws (5/3) – North Carolina's state Senate passed a bill this week that would exempt the UNC Health Care system from federal and state antitrust laws. The bill could increase health care consolidation in the state by making it easier for the University of North Carolina-affiliated hospital system to acquire other health care organizations. In Congress, federal lawmakers are taking the opposite stance on hospital competition. The House Energy and Commerce Committee held a hearing last week on improving transparency and competition in health care, and particularly among hospitals. Lawmakers also introduced a bipartisan bill last week to expand antitrust enforcement of non-profit hospitals. The Biden administration has looked to crack down on anticompetitive practices since taking office, too.
Health Affairs: The Costs Of Disparities In Preventable Heart Failure Hospitalizations In The US South, 2015–17 (5/2) – The annual total cost of preventable heart failure hospital admissions among Black was more than $125 million, with nearly half ($60.8 million) due to differences in rates of admissions for Black compared with White beneficiaries. Failure to deliver appropriate care, use of low-value care, and failure of care coordination are known to contribute to these excess admissions. Increasing the availability of primary care services (for example, through telehealth, addressing clinician shortages, and increasing efficiency) is necessary for reducing preventable admissions.
Yahoo News: EDITORIAL: Merger should put consumers first (5/1) – Even amid a wave of consolidation in the health care industry, Kaiser Permanente's impending acquisition of the Geisinger Health System is a stunning development. The health care consolidation wave has been under way for about two decades, with the number of U.S. hospitals declining from about 8,000 to just more than 6,000 between 1999 and 2021. Multiple studies across that period have shown that the mergers rarely produce the lower prices and improved care that the parties claim beforehand. Some of that decline is due to private equity entrepreneurs acquiring and bleeding hospitals for profit. That is clearly not the case with the Kaiser-Geisinger acquisition. But when it comes time for regulators to examine the acquisition, they should produce clear information on what it will mean for consumers.
Health Affairs: Hospital-Physician Integration Is Associated With Greater Use Of Cardiac Catheterization And Angioplasty (5/1) – Patients of integrated cardiologists were ostensibly as healthy as patients treated by independent cardiologists, which was especially notable, as other research has shown that diagnoses among patients of integrated physicians are coded more aggressively than those of equivalent patients of independent physicians. Patients of integrated cardiologists appeared slightly less likely to receive a cardiac stress test, which is a low-tech diagnostic technique. However, patients of integrated cardiologists were significantly more likely to receive cardiac catheterization, which is a higher-tech procedure, and angioplasty, which is a minimally invasive procedure that, although safe and effective, still entails risks. Together, these results imply that hospital-cardiologist integration may tilt treatment mix toward higher-intensity services. The primary concern from our study is that patients might be subjected to excessive risk simply because of who employs their doctor.
Health Affairs: Have Alternative Payment Models Led To Provider Consolidation? (4/28) – There is limited evidence linking alternative payment models and provider consolidation. Providers can succeed at these models without consolidating. Going forward, researchers should build the evidence base on this topic, and policy makers should consider designing models in ways to reduce incentives for consolidation. To the contrary, consolidation into entities under the same financial management may hurt their performance in alternative payment models. Physician-led ACOs have been shown to reduce spending compared to hospital-led ACOs. Hospital-led ACOs may be hesitant to cannibalize revenues from hospital services for the sake of performing better in ACO models.
RevCycle Intelligence: Less than Half of Primary Care Physicians Participate in Value-Based Care (4/26) – Value-based care participation is lacking among primary care physicians; most practices reported receiving fee-for-service payments in 2022, according to data from the Commonwealth Fund. Specifically, 71 percent of respondents said their practice received fee-for-service payments, while 46 percent reported receiving value-based payments. Around 30 percent of primary care practices reported receiving shared savings or capitated payments. Fee-for-service is likely the dominant payment model in primary care because value-based payment requires significant upfront investments that some underfunded primary care practices cannot afford. Value-based care participation was associated with additional efforts to improve care quality and increased likelihood of screening patients for social drivers of health.
Americans for Prosperity: AFP, 20+ Organizations and Experts Call on Congress to Establish Site Neutral Payments in Medicare (4/26) – Americans for Prosperity joined a coalition of more than 20 prominent organizations and experts in promoting site neutral payments in Medicare. The group sent a letter
to Congress urging lawmakers to take action. This bipartisan solution will reduce costs for patients and discourage hospital consolidation which keeps prices high and limits options among consumers. Joining AFP were representatives from the American Action Forum, Americans for Tax Reform, American Enterprise Institute, Arnold Ventures, Brookings Institution, Committee for a Responsible Federal Budget, Docs 4 Patient Care Foundation, Foundation for Research on Equal Opportunity, FreedomWorks, National Taxpayers Union, Progressive Policy Institute, Texas Public Policy Foundation, Third Way, and more.
Medical Economics: Health care price transparency, competition on the agenda for House (4/26) – The House Energy & Commerce Subcommittee on Health convened April 26, 2023, for a hearing to discuss “the need to improve price transparency in health care as well as improve competition amongst payers and providers of health care to help lower costs for patients.” Primary care network Aledade estimated its accountable care organizations (ACOs) saved more than $535 million for Medicare last year, after other savings in 2021. That happens through real improvements in patient health, such as better diabetes control and blood pressure screenings that cut back hospitalizations and emergency room visits, said Sean Cavanaugh, chief policy officer for Aledade.“ The data clearly show that ACOs grounded in advanced primary care can deliver better care at lower cost, Cavanaugh said. “But that approach is under threat from consolidation and anticompetitive forces. And let's be clear, the evidence is overwhelming, hospital mergers are steadily increasing, horizontal consolidation leads to higher prices, vertical consolidation leads to higher prices. And there's no clear evidence that consolidation leads to higher quality.”