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News Clips
Heritage Foundation: Prescription: Reform Medicare Physician Payments (6/6) – As Congress works on a comprehensive solution, there are some practical changes that could be made to provide some immediate relief. For example, Congress should look beyond Medicare’s MIPS program and make advanced “alternative payment models” (APMs) a more attractive option for clinicians. Under MACRA, as an alternative to participation in MIPS, the law provides physicians opportunities to participate in “advanced” APMs and reap their financial bonuses if they meet certain qualifications. Congress could authorize CMS to designate in Medicare Advantage (MA), Medicare’s system of competing private plans, as participation in an advanced APM. This change would allow more clinicians to become eligible for advanced APM financial incentives and provide doctors an alternative to MIPS and its administrative burdens.
Wall Street Journal: As Hospitals Grow, So Does Your Bill (6/6) – Hospital executives argue that mergers lead to improved efficiency and better outcomes for patients. But, after years of rampant consolidation between hospitals, most regions in the U.S. are now dominated by a few large players. That has led to higher prices and no significant improvements in patient care. Rising costs don’t just lead to alarmingly high medical bills—they also make all of us worse off by increasing premiums, the bulk of which are paid by the nation’s employers. That affects even people who rarely visit a doctor. As those premiums soar and employers look to offset the cost, they indirectly eat into people’s paychecks. “The punchline is the FTC is underfunded, it’s not enforcing enough and, as a result, lots of mergers that raise prices are happening,” says Zack Cooper, a health economist at Yale University and one of the study’s authors. “It’s kind of a death by paper cuts.”
CHCS: Realigning Primary Care Incentives in Medicaid: Six Design Choices for States Pursuing Population-Based Payment (6/5) – Primary care PBP models pay primary care providers (PCPs) an upfront, set amount for each patient served and incorporate provider accountability both for quality and cost of care. This payment approach discourages excessive service volume. Instead, it provides predictable “budgets,” offering providers flexibility to deliver more personalized care and support non-billable services that promote well-being (e.g., increased patient communication through phone calls, texting, or the patient portal; some health-related social needs interventions). When designed with an explicit health equity lens, primary care PBP models can be a key part of efforts to reduce health disparities.
Health Affairs: Advancing Health Equity Through Value-Based Care: CMS Innovation Center Update (6/4) – As implementation yields new insights, the Innovation Center continues to refine approaches to advancing health equity with the goal of incorporating promising features and practices into the Medicare and Medicaid programs. This article provides an update on progress since last year and lays out new work in 2024 in three areas: safety-net provider participation in models to improve care for more beneficiaries, data collection that supports whole-person care, and payment innovations to narrow disparities.
Wall Street Journal: Private Equity Puts Brakes on Healthcare Roll-Ups After Government Scrutiny (6/4) – Private-equity firms have sharply slowed their serial acquisitions of smaller medical businesses, deals that U.S. antitrust regulators say often unfairly reduce competition and harm patients. This year there have been 180 private-equity add-on deals—transactions in which a buyout firm acquires a company to combine with one the firm already owns—in the U.S. health care sector through May 28, just 23 percent of last year’s full-year total, according to data-tracking firm PitchBook Data. While all private-equity activity is down this year, health care roll-ups are down more sharply. All private-equity investment by deal value stands at 34 percent of last year’s total through May 28, while add-on deals in all industries are running at 33 percent of last year’s total by number of deals as of the same date, according to the PitchBook data.
Modern Healthcare: Hospitals push back on bundled care coordination proposal (5/31) – Hospital groups say a proposed mandatory Medicare payment bundling program may prove overly burdensome to an industry already working to implement other Centers for Medicare and Medicaid Services reimbursement experiments. Last month, the Center for Medicare and Medicaid Innovation requested comments on its Transforming Episode Accountability Model, or TEAM, which would employ episode-based reimbursement for lower-extremity joint replacements, femur fracture surgeries, spinal fusions, coronary artery bypass grafts and major bowel procedures at select hospitals for five years starting in 2026. The TEAM policy is still under development and CMS intends to accept comments and flesh it out through future rulemaking.
United States of Care: New Report: The Role of Facility Fees in Prolonging Health Inequities (5/30) – This report shines a light on how certain populations’ access to affordable health care is disproportionately affected by hospital facility fees. The report discusses the disproportionate impact of these fees on communities of color, people with chronic and complex conditions, people in rural communities, and others- a symptom of how health care consolidation nationwide has led to reduced competition, increased prices, and inequitable consumer cost-sharing. It includes a series of recommendations for state and federal policymakers to limit the impact of these facility fees and promote greater health equity.
STAT: Value-based payment is getting renewed attention. What it means isn’t getting any clearer (5/30) – Nearly 20 years ago, policymakers had an epiphany: The health care system should pay for value instead of volume. Unfortunately, it’s now less clear than ever what value-based payment means, and whatever it is, it hasn’t lived up to the hype. Value-based payment, also known as value-based care, is getting renewed attention in Congress as doctors become increasingly distressed by a Medicare pay system that does not keep up with inflation. Lawmakers are considering changes to the way Medicare pays doctors for the first time since Congress passed a law in 2015 that leaned heavily on value-based payment. Whatever Congress does to change physician reimbursement, there will no doubt be talk of improving quality measures, aligning incentives for better outcomes, and paying for better care at lower costs. All of those goals could describe value-based care. Which begs the question: What is value-based care?
Medical Economics: New ACO Primary Care Flex model offered by CMS (5/30) – A new accountable care organization (ACO) model aims to enhance primary care while moving toward the goal of having Medicare beneficiaries in ACOs by 2030. The ACO Primary Care Flex Model, also known as ACO PC Flex Model, will serve as an example of using the MSSP “as a chassis for innovation,” said Elizabeth Fowler. The flexible payment design will empower participating ACOs and their primary care providers to use more innovative, team-based, person-centered and proactive approaches to care.
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