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.
Centers for Medicare and Medicaid Services (CMS): (8/23) – CMS announced the availability of new Research Identifiable Files (RIFs) that contain data from the Next Generation ACO (NGACO) Model for Performance Years 1-3. Two files are available for each payment year. The first file, the NGACO Beneficiary RIF, contains enrollment data for beneficiaries in the NGACO Model. A second file, the NGACO Provider RIF, contains identifying information about the providers participating in the NGACO Model.
CMS: (8/20) – On Friday, CMS released guidance delaying enforcement of the insurer price transparency rule until July 1, 2022. Insurers will now have more time to comply with the requirement to publish machine readable files with their prices.
Rep. Axne (D-IA): (8/20) – Reps. Axne (D-IA), Kind (D-WI), LaHood (R-IL), Sewell (D-AL), and Smith (R-NE) introduced the Keep Physicians Serving Patients Act of 2021 (H.R. 5054), which would improve the accuracy of geographic adjustment factors under the Medicare program and to permanently extend certain adjustments to such factors for certain localities. Bill text
RevCycle Intelligence: (8/18) – The Medical Group Management Association (MGMA) penned a letter to CMS urging the agency to use its authority to prohibit unfair electronic funds transfer (EFT) fees imposed on medical groups by health plans, a trend that continuously cuts into practices’ bottom line and exemplifies predatory business tactics.The letter cited a recent MGMA Stat poll finding that 57 percent of medical practices reported being charged fees by payers that they did not agree to when sending EFT payments.
JAMA Network: (8/13) – Aledade’s Sean Cavanuagh and Farzad Mostashari identified five key features of Medicare that have been a catalyst for value-based care and highlight structural changes needed in Medicaid for value-based programs to thrive.
National Association of Accountable Care Organizations (NAACOS): (8/24) – Twelve leading healthcare organizations are asking Congress to include a bipartisan House bill that will accelerate Medicare’s move to value-based payment in the upcoming reconciliation bill. In a letter sent today to Senate Finance Committee Chair Ron Wyden and House Ways and Means Committee Chair Richard Neal, the groups point to a recent, independent analysis by the Moran Company that shows the Value in Health Care Act (H.R. 4587) would save $280 million over 10 years.
Fierce Healthcare: (8/23) – The Biden administration has delayed enforcement of key parts of a major insurer price transparency rule by six months until July 1, 2022, to give plans more time to comply. CMS announced the change in a new guidance focusing on the final price transparency rule released last October under the Trump administration. The guidance focuses on a requirement that certain health plans disclose online their in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for certain items and services.
AJMC: (8/23) – Health systems and provider groups currently lack a systematic mechanism to evaluate the financial implications of value-based alternative payments. The authors sought to develop a method to prospectively quantify the financial implications, including risk and uncertainty of (1) transitioning from a fee-for-service to an episode-based payment model and (2) modifying episode-specific clinical cost drivers.
Fierce Healthcare: (8/23) – A federal appeals court has shot down several hospitals’ latest bid to get higher Medicare payments for high-cost patients. The U.S. Court of Appeals for the District of Columbia issued the ruling Friday, striking down the latest bid from a lawsuit brought by more than a dozen hospitals and clinics.
The New York Times: (8/22) – The New York Times conducted an analysis of hospital prices that shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test. And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.
Fierce Healthcare: (8/20) – Physician pay barely increased in 2020, while productivity plummeted due to the pandemic according to the latest AMGA medical group compensation and productivity survey, which reached nearly 400 medical groups representing more than 190,000 providers. AMGA Consulting President Fred Horton said transitioning to value-based compensation structures will create more resiliency against “future economic downturns."
JAMA Network: (8/20) – In this article, the authors found that receiving care simultaneously under a Medicare accountable care organization (ACO) and bundled payments is associated with better patient outcomes compared with bundled payments alone. In this cohort study of 9, 850, 080 Medicare beneficiaries, simultaneous inclusion in both ACOs and bundled payments was associated with lower spending on institutional postacute care, fewer readmissions for medical episodes, and fewer readmissions only for surgical episodes compared with inclusion in bundled payments alone.
Modern Healthcare: (8/20) – Combining accountable care organizations and bundled payments can save more money and deliver better outcomes for patients than bundled payments on their own. Post-discharge spending for Medicare beneficiaries with a medical condition was five percent, or $323, lower on average if a beneficiary was in an ACO and a bundled payment system at the same time instead of a bundled payment system alone. However, the combination of an ACO and bundled payments had no meaningful impact on spending for surgical episodes.
Modern Healthcare: (8/19) – In this article, the authors argue it's time for hospitals and health systems to start getting ready for the surprise billing ban that takes effect next year. President Joe Biden's administration published an interim final rule last month that covers the basics, but left out essential details about how the No Surprises Act will work in practice.
Patient Engagement HIT: (8/18) – Value-based care is an unfamiliar concept to most patients, but the majority of surveyed healthcare consumers said they would support a system where providers are paid based on value rather than volume, according to new data from PointClickCare. About a third of survey respondents between the ages of 25 and 34 said they had heard of and understood the concept of value-based care. However, only seven percent of 55- to 64-year-olds and four percent of respondents over 65 reported ever hearing about value-based care.
Fierce Healthcare: (8/18) – The American Hospital Association (AHA) wants to make its case to the Biden administration that hospital mergers are not negatively impacting prices or quality, asking for a meeting with key cabinet members on the issue. The hospital advocacy group wrote a letter to the leaders of the Department of Health and Human Services (HHS), the Department of Justice (DOJ) and the Federal Trade Commission (FTC) offering updated industry-funded studies on the impact of mergers.
RevCycle Intelligence: (8/17) – CMS will hold off on hospital price transparency noncompliance penalties for the moment, a CMS spokesperson told Bloomberg Law. CMS proposed an increase in penalty amounts for noncompliant hospitals in the Medicare Outpatient Prospective Payment System (OPPS) proposed rule issued in July. The news arrives just a few months after CMS began sending letters to noncompliant hospitals. CMS sent 165 warning letters as of mid-July. The warning letters state that hospitals have 90 days to address their noncompliance before additional actions will be taken. However, the agency has not yet issued any fines to hospitals.
JAMA Network: (8/16) – In this article, the authors found that state surprise-billing legislation appears to directly lower out-of-network prices and indirectly lower in-network prices by changing payer-practitioner negotiating dynamics. This analysis of more than 2.5 million claims filed for patients with private health insurance who received anesthesia services in hospital outpatient departments and ambulatory surgery centers from 2014 to 2017 found that prices paid to out-of-network anesthesiologists at in-network facilities and to in-network anesthesiologists decreased in California, Florida, and New York after each state passed comprehensive surprise-billing legislation.