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 Statement on CMS Strategy Refresh
We were pleased to see that CMMI incorporated many of our recommendations into their refresh strategy, and applaud them for listening to PEPC and the independent physician community. Physicians are leading the value-based care movement. The details will be crucial but the steps outlined by PEPC and CMMI will pave the way for greater model participation by smaller, independent practices.
Centers for Medicare and Medicaid Services (CMS): (10/21) – CMS released the fourth evaluation report for the Next Generation Accountable Care Organization (NGACO) model. As of PY4, the NGACO Model was associated with $667 million in gross Medicare savings. After factoring in $909 million in shared savings and other payouts to NGACOs, the Model was associated with $243 million in net losses. On average, total gross spending reductions did not differ by NGACO organizational affiliation. However, physician practice NGACOs were more likely to reduce spending in acute care hospital and outpatient facility settings.
House Energy and Commerce Committee: (10/20) – House Energy & Commerce Committee Chair Pallone (D-NJ) and Senate HELP Committee Chair Murray (D-WA) sent a letter to HHS Secretary Becerra, Department of Treasury Secretary Yellen and Department of Labor Secretary Walsh voicing support for the Biden Administration’s Interim Final Rule (IFR) implementing key provisions of the No Surprises Act.
Rep. Burgess (R-TX): (10/19) – Reps. Burgess (R-TX) and Rush (D-IL) introduced H.R. 5612, which would provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule. This legislation will provide critical relief to physicians and health care providers facing the looming Medicare payment cuts by using unobligated funds from the Provider Relief Fund to offset costs.
California Medical Association (CMA): (10/23) – San Diego physician Robert E. Wailes, M.D.,was installed as president of the CMA at the association’s annual House of Delegates (HOD). In his address to the delegates, Dr. Wailes—a Southern California pain specialist and board-certified anesthesiologist—recognized the great challenges and great accomplishments the profession of medicine faced over the past year.
American Academy of Family Physicians (AAFP): (10/20) – The AAFP this month lauded legislation that would allow employers and health plan sponsors to waive primary care and telehealth deductibles through the end of 2023 for patients covered by high-deductible health plans. The Primary and Virtual Care Affordability Act (H.R. 5541) would “ensure that patients can access primary care — both in person and virtually — which is especially critical during the ongoing pandemic to keep patients out of the hospital, address lapses in care and catch them up on missed routine and preventive services,” the AAFP said.
Fierce Healthcare: (10/25) – The National Association of ACOs (NAACOS) released a white paper Monday outlining key recommendations on how CMS can use ACOs to help close equity gaps. The paper calls on the Biden administration to develop new quality measures and create bonuses to help ensure accountable care organizations can address health equity.
Fierce Healthcare: (10/25) – Many providers recognize the benefits of tracking social risk factors, but they say lack of integration with workflow and payment systems make widespread adoption challenging. Social risk data also do not tend to live within the electronic health record, but rather in siloed databases or social service systems. Additionally, when physicians notice the impact of social determinants but lack the tools to make a meaningful difference, burnout accelerates. As a result, compensating physicians accordingly and incorporating social determinants into payment models is key to success.
Fierce Healthcare: (10/22) – The Next Generation accountable care organization model, which is being shuttered after this year, saved Medicare $637 million in 2020. The data, released Thursday by CMS, come as ACO advocates want the agency to give organizations more options to take on financial risk. NAACOS’ analysis of performance data showed that the number declined to $230 million after accounting for shared savings paid out to the ACOs.
Modern Healthcare: (10/22) – For years, patients have complained they often do not know how much hospitals charge for healthcare services until they are billed, unlike other commercial products such as gasoline, clothes or housing. But published hospital prices show wide variations in prices — up to eight times — for the same care, demonstrating to advocates that price transparency can help consumers shop for the best prices..
American Medical Association (AMA): (10/22) – The rise of health system and hospital ownership of primary care practices raises policy questions about the survival of independent physician-owned practices. Tis study found that a substantial proportion of Family Practices in 2017–2019 remained in independently owned practice: 81 percent of solo practitioners and 35 percent of Family Practice in practices with 2–5 clinicians. These findings suggest that independent practice is surviving, and that it's incumbent on researchers, payers, and policymakers to better understand their unique contributions and challenges in the effort to improve primary care access, quality, and cost.
Modern Healthcare: (10/21) – Jonathan Blum, principal deputy administrator of CMS, questioned the future of Medicare Advantage payments Thursday, pointing to studies from government watchdogs and experts. "We too are very concerned with the overall trend lines for code growth in the MA program versus the overall fee-for-service program...Should we use a benchmark? Should we try something else going forward for risk adjustment purposes and for overall benchmark purposes?" Blum said.
Fierce Healthcare: (10/21) – Biden administration officials want more information from Medicare Advantage (MA) plans on how key benefits are helping underserved patient populations. Officials with the Centers for Medicare & Medicaid Services (CMS) discussed the need for greater collaboration during a conference this week sponsored by the Better Medicare Alliance. Officials said they want to better understand the impact of incentives in the MA program to address health equity and to spur more participation in the value-based insurance design (VBID) model.
RevCycleIntelligence: (10/20) – A group of healthcare organizations, led by the National Association of ACOs (NAACOS), has asked CMS to provide accountable care organizations (ACOs) with the option to use pre-pandemic years to set Medicare Shared Savings Program (MSSP) benchmarks. Under current CMS policy, ACOs that renew MSSP agreements and new ACOs that enter the MSSP in 2022 will receive benchmarks that are based on spending targets from 2019 to 2021.
MedCity News: (10/20) – Chiquita Brooks LaSure, CMS Administrator, expressed concerns about mandatory models from an equity perspective. The agency leadership has said they are considering making more of its experimental models mandatory rather than voluntary, as this will help generate system-level savings and prevent situations where providers cherry-pick the models in which they participate. However, Brooks LaSure stressed that it is important to ensure that the providers who don’t have the capital or resources to participate in these models are not left out if they are made mandatory.
Modern Healthcare: (10/20) – The Biden administration hopes to increase participation in alternative payment models as a way to save the government money and improve care for beneficiaries. Purva Rawal, chief strategy officer for the Center for Medicare and Medicaid Innovation said the administration wants to "accelerate" the movement to value-based care through Accountable Care Organizations and other models. Rawal specifically mentioned direct contracting models, which allow more types of organizations to participate in risk-sharing arrangements. "That's really our third generation ACO model that we're really building on," Rawal said.