News Clips
Fierce Healthcare: ACOs want increased participation of long-term and post-acute care providers (2/21)
– Accountable care organizations are calling on the feds to increase participation of long-term and post-acute care providers in ACOs and to better incorporate episodic-based payments. The recently released white paper highlights ways the ACO REACH Model and Medicare Shared Savings Program (MSSP) can be utilized to grow participation. "If CMS is to achieve its goal of having all Medicare beneficiaries in an accountable care relationship by 2030, then it must take steps to better include provider types less represented in ACOs, including SNFs,” said NAACOS Senior Vice President Aisha Pittman.
Familes USA: A Pro-Consumer Policy Agenda To Achieve Meaningful Health System Transformation (2/20)
– This Agenda outlines six policy priorities necessary to shift America’s health care payment and delivery system away from the inefficiencies of fee-for-service and toward population-based economics that truly meet the health needs of people in the U.S. The Agenda encourages policymakers to pursue policy solutions across six priority areas, including strengthening primary care and promoting healthy competition.
KFF Health News: In California, Faceoff Between Major Insurer and Health System Shows Hazards of Consolidation (2/19)
– A KFF analysis found widespread evidence that consolidation of health providers leads to higher health care prices for private insurance. The same brief from 2020 found some evidence suggesting that large, consolidated insurance companies are able to obtain lower prices from providers, but that has not necessarily led to lower premiums for patients. And a 2022 report from the California Department of Health Care Access and Information found that health care costs have grown “at an unsustainable rate,” and noted that between 2010 and 2018 “health insurance premiums for job-based coverage increased more than twice the rate of growth for wages.” State regulators also found that health plans spent nearly $1.3 billion more on prescription drugs in 2022 than in 2021.
STAT: Independent doctors like me are becoming an endangered species (2/15) – More than 100,000 doctors have left private practice and become employees of hospitals and other corporate entities since 2019. Today, nearly three in four physicians are employees of larger health care entities or other corporations — a record high. As an independent physician, I know exactly why so many are making that choice. My four-doctor gastroenterology practice came under severe stress in 2007 due to catastrophic fee schedule cuts from our two largest payers. Luckily, I was able to join forces with other local independent docs to form a bigger group practice.
Fierce Healthcare: 'A giant unknown': What the alleged $2B Medicare catheter fraud scheme means for ACOs (2/15)
– NAACOS wants the OIG to pay closer attention to fraud reports it receives from ACOs, and it wants to work with CMS to improve the reporting process, a spokesperson said. Despite the troubles ACOs faced in this ordeal, the association says this is why ACOs are so valuable, as fraud detection is more identifiable. NAACOS is also pushing for improved communication between Medicare administrative contractors. Beyond that, it seeks more provider participation and advocates for extending the alternative payment model incentive. "What I worry about is that the pendulum swings too far and legitimate claims then begin to be held for unnecessary administrative burden," said Jobes. "I do worry that if CMS tightens the screws too much, cash flow for providers are adversely impacted. It's a double-edged sword." Diabetic supplies and skin grafting utilization has also caught the attention of NAACOS. Could this same situation be happening right now with other products?
Milliman: Shadow bundles: A big opportunity for MSSP and REACH ACOs (2/13) – CMS is planning to release shadow bundles data to ACO participants (including those participating in the MSSP and ACO REACH models) to provide increased transparency into hospital and specialty care. Results of a CMS poll indicated “95 percent of ACO respondents were likely or very likely to utilize shadow bundles data to support better specialty engagement.” This paper outlines information ACOs in the MSSP and ACO REACH models will receive when this data is released in early 2024, how it can be used, and other considerations in using provider performance benchmarking data to better manage specialty care.
STAT: Lawmakers eye partial increase for Medicare doctor pay (2/13) – Lawmakers are considering increasing doctors’ Medicare pay in an upcoming government funding package, but their policy would only partially offset cuts providers saw earlier this year, three lobbyists and two sources familiar with the talks told STAT. Physicians’ groups have agitated for Congress to undo a roughly 3.4 percent Medicare pay cut this year, resulting from the expiration of pandemic-era bonuses lawmakers chose to give the industry. The cut went into effect on Jan. 1, but a fix hasn’t entirely fallen off of the agenda. A pay increase was discussed in negotiations over a stopgap funding bill earlier this year.
Fierce Healthcare: Industry Voices—Why is it so hard to measure the impact of primary care? (2/13) – As accountable and full-risk payment structures grow in market share and popularity, there is a pressing need to redefine how success in primary care is measured. Though change is starting to materialize in the form of simplified measures with ACO REACH and CMS adoption of a patient-reported outcome measure (PROM) for person-centered care, it is simply not enough. Without the tools to uniformly assess impact in a meaningful way, we are robbed of the ability not only to chart progress but also to inform and accelerate iterative innovation. Primary care is experiencing an unprecedented degree of investment and interest in health care; rapid growth is happening now. With thoughtful alignment on measurement, we can rise to fully meet the promise of this moment.
Medical Economics: New year brings new value-based care opportunities (2/12) – As we move into 2024, health care is experiencing unprecedented digital innovation and transformation. New technologies and capabilities are emerging to enable organizations – including payers, providers, and self-funded employers – to confidently take on risk in value-based care (VBC) programs. The American Academy of Family Physicians reports that 49 percent of practices are participating in some form of value-based payment, and the Centers for Medicare and Medicaid Services (CMS) is still pushing its goal of having all Medicare and most Medicaid beneficiaries in accountable care relationships by 2030. The VBC model incentivizes providers and payers to deliver higher quality care and optimize patient outcomes while reducing costs. VBC has gained significant traction in recent years, and its momentum is only expected to increase. Health care delivery organizations prepared for these changes will thrive in a value-based future.
Milliman: The winding road to value: Understanding VBC dynamics in each market (2/12) – Market trends suggest that a solid understanding of how to succeed in value-based payment arrangements is necessary for providers now and going forward. Value-based care contracting has become increasingly common in the U.S. health care system and abroad. It is estimated that in 2022 about 41 percent of health care payments in the United States were based on some form of value-based contracting linked to the cost of care. This white paper looks at some of the key dynamics that are driving the shift to value-based care in the following markets: Medicare fee for service, Medicare Advantage, Commercial and Medicaid.
Medical Economics: Navigating primary care partnerships: strategic considerations and transaction trends (2/12)
– The importance of primary care professionals – to manage a patient’s overall health, to reduce complications and to provide preventive care – is underscored by many factors, including:
- Accelerating attention to, momentum of investment in, and more recent evolution of, value-based care and reimbursement programs, such as risk-based initiatives, bundled payments and enhanced quality and outcome analyses, as payers, providers, employers and other participants in the health care industry have developed more enhanced value-based capabilities; and
- Increasing financial incentives for implementing such programs to lower the overall cost of quality care, such as catching illnesses (e.g., cancer, hypertension, chronic obstructive pulmonary disease, diabetes) early and avoiding the need for inpatient and other expensive care, and emphasis on reducing hospital readmissions.
STAT: FTC doubles down in Welsh Carson anesthesia case to limit private equity’s physician buyouts (2/12)
– Lina Khan’s Federal Trade Commission is eager to make Big Physician a lot smaller. Last September, the FTC sued private equity firm Welsh, Carson, Anderson & Stowe and U.S. Anesthesia Partners, alleging the two parties conspired to create monopolies for anesthesia services. Both Welsh Carson and USAP have tried to get the case thrown out, but the FTC recently doubled down. The agency asked the judge last month to ignore those companies’ pleas, calling their arguments “unavailing” in recent legal filings. It’s not surprising the FTC is spending more time and resources on a lawsuit it initiated. But experts say the agency’s meticulous arguments and persistence to put Welsh Carson and USAP’s business strategy on ice sends the clearest warning yet: Firms that try to consolidate markets for physician services as a means to jack up prices won’t get away without a fight.
STAT: States are ramping up scrutiny of health transactions, as more provider groups look for buyers (2/12)
– UnitedHealth Group’s Optum has bought an untold number of physician practices over the years. It either owns or is affiliated with over 90,000 providers — almost 10 percent of all U.S. physicians. That’s mostly happened quietly. But a new Optum purchase in Oregon is getting outsize scrutiny from state regulators — a trend experts say is actually on the rise. Oregon is at the forefront of the push for more scrutiny; it already has some of the strongest health care market oversight laws in the nation. But state legislatures in Illinois, Minnesota, and New York approved similar oversight programs last year, meaning deals in those states will start getting more scrutiny soon. And five more states, Vermont, Washington, Pennsylvania, Indiana, and New Mexico, are already looking at legislation to start or expand their own programs.
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