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.
CMS: (6/28) - CMS announced Monday that Daniel Tsai has been appointed to oversee Medicaid and the Children's Health Insurance Program (CHIP). Tsai previously served as the Assistant Secretary for MassHealth and Medicaid Director for Massachusetts, where he led the program through restructuring aimed at a shift towards value-based care.
CMS: (6/28) - CMS released the CY 2022 Home Health Prospective Payment System proposed rule. Among other proposals, the rule would expand nationwide the Home Health Value-Based Purchasing (HHVBP) Program. CMS also proposes to make permanent selected regulatory blanket waivers related to home health aide supervision and the use of telecommunication that were issued to Medicare participating home health agencies during the COVID-19 public health emergency (PHE). Fact sheet
CMS: (6/24) - CMS Administrator Brooks-LaSure sent letters to Indiana and Arizona withdrawing approval of their states’ mandate that adults work, volunteer or attend school in order to get Medicaid coverage. She indicated that the work requirements in Arizona and Indiana “are not likely to promote the objectives of the Medicaid statute.”
CMS: (6/24) - CMS announced that beginning July 1, 2021, the anti-kickback statute safe harbor for CMS-sponsored model patient incentives is available to protect the Maternal Opioid Misuse (MOM) Model Beneficiary Incentives.
Aledade: (6/25)- Aledade CEO Farzad Mostashari hosted a webinar last week highlighting how primary care can reduce total cost of care through improved quality and prevention, illustrating how physician-led ACOs are achieving higher level of success in value-based care and identifying strategies enabling practices to thrive across diverse markets with value-based care.
PR Newswire: (6/24) - Eleven organizations announced the formation of Primary Care for America, a collaboration focused on demonstrating the value of primary care, the need for increased primary care investment, and the importance of innovation in primary care delivery and payment models. Key partners in the campaign include: Aledade and American Academy of Family Physicians.
MGMA: (6/24) - Luring patients back to medical practices is no longer one of the top concerns for practice administrators; instead, it’s bringing highly qualified staff onboard to serve them. A June 22 MGMA Stat poll found that 33 percent of medical practices have added or expanded bonuses to recruit staff this year, while 9 percent are considering it.
AAFP: (6/24) In recent written testimony to congressional leaders, AAFP reiterated family physicians’ crucial role in vaccine counseling and delivery, as well as in instilling vaccine confidence — including, but not limited to, ongoing COVID-19 immunization.
Aledade: (6/23) – Aledade and the Cooperative of American Physicians, Inc. (CAP) announced a new collaboration designed to support CAP member physicians in the transition to value-based care.
Modern Healthcare: (6/29) – According to a new report from the Physicians Advocacy Institute, almost seven in 10 U.S. physicians are now employed by hospitals or corporations like private equity firms and health insurers. Between January 2019 and January 2021, 48,000 physicians quit private practice to take jobs at hospitals or other companies.
Modern Healthcare: (6/28) – The Oregon legislature passed a bill that would bolster health care merger and acquisition oversight, with a focus on preserving services for underserved communities. Oregon regulators would have to sign off on any merger, acquisition or affiliation that would increase a health care organization's net patient revenue by $1 million or more. A similar bill was proposed in California (SB 977) but it stalled late last year before reaching the Assembly or Senate. In Congress, Sen. Amy Klobuchar (D-MN) co-authored a bill that recently passed the House Judiciary Committee, which would bolster antitrust enforcement. It would add $300 million to each of the Justice Department and Federal Trade Commission's budgets, increase merging filling costs for the largest transactions, update the standard for permissible mergers, and shift the burden of proof to the merging parties, among other provisions.
Fierce Healthcare: (6/28) – Only nine percent of adults know that hospitals are required to post the prices of treatments and procedures on their websites, according to a recent survey. Similarly, just 14 percent of respondents said they or a family member had gone online to research the price of a hospital’s treatment within the past six months. This data suggests low consumer awareness and utilization of the CMS price transparency rule, which went into effect for hospitals on January 1, 2021.
Health Care Exec Intelligence: (6/28) – Pediatrics is often left out of value-based care conversations, particularly specialty pediatrics. In the most recent episode of Healthcare Strategies, an Xtelligent Healthcare Media podcast, Larry Epstein, CEO of Pediatric Urology Associates, discussed what that means for his organization and others like his.
Health Affairs: (6/24) – Author Ken Terry argues that putting providers at financial risk will reduce overall health care spending. Given the right incentives through prospective payments and value based care, providers could cut the amount of waste under their control in half. Although physician organizations such as ACOs have made the most progress on this front, Terry argues that progress has been slower than necessary and that a public option would be the most effective lever to speed the transition.
Milbank Memorial Fund: (6/24) – This Issue brief argues that decades of ineffective antitrust enforcement have left many US health care markets with insufficient competition to control prices and that effective oversight of market conduct requires collaboration between state and federal policymakers. This brief describes actions taken by federal and state policymakers to address the consequences of health care provider concentration through increased price transparency, improved merger review, oversight of anticompetitive conduct, and increased competition through a public option.
Modern Healthcare: (6/23) – A study by University of Minnesota School of Public Health faculty found that only 23.7 percent of hospitals reported all required data on service rates in both machine-readable and consumer-shoppable formats. System affiliated and private, not-for-profit hospitals were more likely to provide data in a consumer-friendly format than independent and public hospitals. For profit-hospitals were more likely to comply with the rule than public hospitals. Payer-specific negotiated rates, which are the prices hospitals agree to charge individual insurance companies for patient care, were the least likely to be publicly disclosed by hospitals in the study.