News Clips
The Hill: Opinion - To make health care cheaper, make it more expensive (11/21) – Higher rates mean that more independent hospitals have a chance to survive, providing communities with more access, choice and savings. When health care providers are adequately compensated, they have more resources to invest in patient care. This includes spending more time with each patient, investing in the latest medical technologies and adopting innovative treatment methods. Better care often means more accurate diagnoses, more effective treatments and faster recoveries — all of which can reduce long-term health care costs by preventing complications and reducing the need for repeat treatments.
HCP-LAN: Guidance for Health Care Entities Partnering with Community-Based Organizations: Addressing Health-Related Social Needs in Alternative Payment Models (11/21) –This publication is one piece of a larger, long-term effort to address equitable health outcomes in payment reform. The Health Care Payment Learning & Action Network (HCP-LAN) Health Equity Advisory Team (HEAT) is calling on health care entities to focus on and authentically engage the communities they serve in APM design and implementation—and to partner with community-based organizations (CBOs) to provide essential social benefits and services to patients through new and innovative care payment and delivery models. This document provides guidance for CBO engagement across four key themes. These themes, informed by interviews with CBOs and community care hubs, are generally geared towards health care entities except where the audience is explicitly noted.
AJMC: AMA Continues Call for Medicare Payment System Fix During Interim Meeting (11/20) – The American Medical Association (AMA) is calling for a fix to what it calls a flawed Medicare payment system. The 2024 payment scheduled called for a 3.4 percent cut to physicians. However, the Medicare Economic Index, which is a measure of inflation in medical practice costs, will be 4.6 percent in 2024. According to AMA, the payment cut combined with inflation results in an eight percent decline in physician payment. While CMS has announced changes to programs, like the Medicare Shared Savings Program, that have garnered praise from some in health care, there are widespread concerns over the 3.4 percent cut to physician fees.
Fremont News Messenger: Letter to the Editor: Congress should support FAIR Act to protect patients (11/20) – When hospitals and corporations buy out independent practices, the acquired facilities are then considered hospital outpatient departments (HOPDs). HOPDs charge higher prices for the same service offered before they came under new ownership. Oftentimes, patients don’t realize they are paying more until after they receive their bill. These practices stemming from consolidation create instability in the health care marketplace, lead to financial stress among patients — and result in more patients having a hard time finding affordable care. Representatives in Washington can stop this practice by supporting the Facilitating Accountability in Reimbursements Act (FAIR) in the House and the Site-based Invoicing and Transparency Enhancement Act (SITE) in the Senate. Both bills would implement fair hospital billing practices across the industry.
Berkeley Research Group: Transitioning to Value-Based Care: Financial Implications for Providers and Policymakers (11/16) – Understanding the size and nature of transition costs is a key question for policymakers aiming to promote value-based care. While previous analyses have estimated the cost of transitioning to value-based care, this white paper provides a qualitative description of the three main types of transition costs: care delivery costs, start-up administrative costs, and financial costs.
- Care delivery costs include clinical solutions that improve care for patients most likely to incur the highest avoidable costs, and the technology solutions that help providers identify who those patients are and what types of interventions should be introduced.
- Start-up administrative costs consist of financial modeling to justify a move to value-based care, organizing to take on value-based contracts, and other operational preparations required for success once a value-based arrangement begins.
- Financial costs are like those of other investments: a lag between starting and realizing profits, the risk of not realizing financial return, and upfront capital requirements that may include working capital, collateral, and financing costs.
STAT: Doctors divide over reforming a secretive panel that determines their Medicare pay (11/17) – Doctors are splitting, specialty by specialty, over whether and how to overhaul a secretive panel that helps determine how much Medicare pays them for their work. Doctors who get paid more by Medicare generally like the way the panel operates now. But doctors who are paid relatively less are looking for ways they say would make the process more fair. And Medicare officials are clearly considering the issue: their latest regulations included more than 20 pages dedicated to the topic of whether the process needs an overhaul. A subgroup of physicians — mainly led by family physicians and internal medicine physicians — wants to change the way the committee makes those calls. Other physicians, however, hailing from highly paid specialties like surgery, radiology, and dermatology, said quantitative data does not adequately reflect how much work it takes to complete each procedure or service.
Fierce Healthcare: CEO Farzad Mostashari: How early failure at Aledade helped the company evolve (11/17) – Aledade also represented five of the 10 highest-performing ACOs in the program, despite representing just seven percent of covered lives in the Medicare Shared Savings Program (MSSP). It generated more than $572 million in savings for 2022 alone, according to data from the Centers for Medicare & Medicaid Services. "It comes with time," Mostashari said. "But you can't get better if you can't honestly look at where things aren't working." However, while value-based care has grow slowly but steadily in Medicare, there's still plenty of work to be done in helping other insurance segments catch up to what Medicare Advantage (MA) and the traditional program have accomplished.
KFF Health News: Compensation Is Key to Fixing Primary Care Shortage (11/16) – Substantial disparities between what primary care physicians earn relative to specialists like orthopedists and cardiologists can weigh into medical students’ decisions about which field to choose. Plus, the system that Medicare and other health plans use to pay doctors generally places more value on doing procedures like replacing a knee or inserting a stent than on delivering the whole-person, long-term health care management that primary care physicians provide. As a result of those pay disparities, and the punishing workload typically faced by primary care physicians, more new doctors are becoming specialists, often leaving patients with fewer choices for primary care. A $26 billion piece of bipartisan legislation proposed last month by Senate Help Committee Chair Sanders (I-VT) and Sen. Marshall (R-KN) would bolster primary care by increasing training opportunities for doctors and nurses and expanding access to community health centers. Policy experts say the bill would provide important support, but it’s not enough. It doesn’t touch compensation.
Medical Economics: ‘Independent medical practices are not dead’ (11/16) – The new American Independent Medical Practice Association (AIMPA) launched in October to be a new voice for independent doctors across all specialties, including primary care, internal and family medicine. “We have some very smart physicians who are very much determined to remain independent, and are also very much in the mindset of protecting our profession and our patients and delivering the care that we want to deliver, the way we want to deliver it, because we know that's a great way to practice medicine. Our focus right now is on policymakers. We need to make sure that policymakers are aware that private practice, independent medical practice is alive and well, and that we are an integral part of the communities in which we are based, in the patients whom we serve. We were on Capitol Hill recently talking to multiple members of Congress. We found very receptive audiences to this. People will say, look, these physicians are important, integral members of the medical community and they are shrinking – different rates of contraction among different specialties, but they're under threat.”
Fierce Healthcare: Humana: How value-based care can improve the patient, provider experience (11/16) – Value-based care leads to a better patient experience—and a better experience for physicians, too, a new study from Humana shows. Patients treated under value-based care models are also more engaged with preventive and primary care, according to the report. Most (85 percent) saw their primary care provider at least once in 2022, compared with 75 percent of those in not-value-based programs. Humana saw 30.1 percent fewer inpatient admission in 2022 for its value-based care population compared to those enrolled in traditional Medicare, saving 214,000 admissions. In addition, there were 12.7 percent fewer visits to the emergency room compared to the fee-for-service population, the report found.
Washington Center for Equitable Growth: The consequences of U.S. hospital consolidation on local economies, healthcare providers, and patients (11/15) – Policymakers, regulators, stakeholders, and academics have yet to grapple with the full cross-sectional impacts of hospital mergers. While the evidence is clear that consolidation leads to higher prices in concentrated markets, evidence is mixed on how it impacts the communities in which it occurs, how consolidation affects health care providers subject to acquisitions, and how those providers’ patients are affected after mergers are completed. Answers to all these broad questions require further research. Despite these gaps, there is some evidence of the broad consequences of hospital consolidation. More evidence is needed to develop policies and models of antitrust enforcement that mitigate the harmful impacts of hospital consolidation while bolstering the positive consequences of these mergers. In areas where evidence is mixed or missing, this report recommends specific topics of investigation to researchers.
Healthcare Innovation: AAFP, Elation Execs Discuss Keys to Success in Value-Based Care (11/13) – Healthcare Innovation published a news item about an AAFP Innovation Lab, study focused on barriers and potential solutions to allow for mainstream adoption of value-based payment models in primary care and how these issues relate to physician burnout. Dr. Steven Waldren, AAFP, and Dr. Sara Pastoor, Elation Health, spoke more depth about this research. “I think that we have seen positive evolution in those models. CMS and CMMI are learning and evolving those models in the right direction. I like that they are offering upfront investment to practices that don't have experience with value-based payment to help them hire additional staff, invest in technology, and develop those new processes and competencies so that they can get over that hump.”
RevCycle Intelligence: Understanding the Fundamentals of Accountable Care Organizations (11/13) – The health care payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many value-based care models, accountable care organizations (ACOs) are among the most popular and successful models to date. According to CMS, ACOs are groups of physicians, hospitals, and other health care providers who voluntarily coordinate care for patients with the goal of delivering high quality care. ACO participants also agree to take on responsibility for the total costs of care for their patients. ACOs that reduce the total costs of care for their patient populations can share in the savings with the payer. In certain models, they may also be liable to pay back losses if their costs exceed their spending benchmarks. Policymakers and health care leaders believe tying financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system.
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