January 22 - February 5, 2025

Welcome to The Partnership to Empower Physician-Led Care biweekly 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 News  

PEPC is excited to support the fourth annual #HealthCareValueWeek, which starts on 2/24! We’ll be joining health care thought leaders in conversations to shift our current health care approaches to one that prioritizes quality of care.  Kristen McGovern, our Executive Director, will moderate a virtual panel, "Fostering Competition: Supporting Providers Through a Value-Based Health System" on 2/25 at 1pm. 

For more information and registration, visit: https://hcvalueweek.org/

Administration News  

CMS: (1/21) – CMS released an article highlighting spillover impacts of Innovation Center models. Models affect the overall health care delivery system beyond participating organizations. Interviews with providers, payers, management services organizations, and industry and academic experts examine the drivers of spillover effects from the CMS Innovation Center’s programs.

 Legislative News  

Medicare Patient Access and Practice Stabilization Act: (1/31) – A group of ten bipartisan House members introduced the Medicare Patient Access and Practice Stabilization Act, which would offset the 2.8 percent Physician Fee Schedule cut which went into effect January 1, 2025. The legislation would increase Medicare physician payment by 6.62 percent from April 1, 2025 through January 1, 2026. PEPC urges swift passage for the legislation and looks forward to continuing to work with Congress to address longer term solutions to physician reimbursement.

• MGMA: (1/31) – Medical Group Management Association (MGMA) released a statement on the Medicare Patient Access and Practice Stabilization Act. “With nearly 80% of all physicians now employed by facilities and larger entities, Medicare beneficiaries in areas of the country that rely solely on community-based medical practices are especially vulnerable to access issues. Without immediate congressional action on this important legislation, more and more physician practices will be forced to close their doors, unable to keep up with rapidly rising staff salaries, rent, and administrative costs.”
• CMA: (1/31) – California Medical Association (CMA) released a statement on the 2.8 percent cut to Medicare reimbursement physicians faced January 1, 2025. “When medical practice inflation is factored in, this is in effect a 6.3% payment cut to physicians. Many Congressional leaders in both parties have since vowed to reverse the cuts in the March 14, 2025, legislative package to keep the government funded. But for now, the cuts are in effect and claims are being paid at the lower amount until Congress intervenes.”

Preserving Patient Access to Accountable Care Act: (1/28) – Reps. LaHood (R-IL), Dunn (R-FL), DelBene (D-WA) and Schrier (D-WA) introduced the Preserving Patient Access to Accountable Care Act which would extend the advanced alternative payment model (APM) incentive payment at 3.53 percent through payment year 2027 and freeze the qualifying thresholds increase.

News Clips  

Modern Healthcare (2/3) Hospitals seek post-acute partners for Medicare TEAM demo – A year ahead of the implementation of a mandatory Medicare payment demonstration, hospitals are on the lookout for post-acute care providers that can help them prevent lost reimbursements. CMS finalized the Transforming Episode Accountability Model, or TEAM, in August. It takes effect in 2026 and runs for five years. TEAM sets payments for 30-day episodes of care for lower-extremity joint replacements, femur fracture surgeries, spinal fusions, coronary artery bypass grafts and major bowel procedures. Looking ahead, hospitals and their post-acute partners should think carefully about how to structure gainsharing agreements. Factors include the amount and types of financial risk hospitals and post-acute care partners take on and how they divide savings and losses.

Wall Street Journal (1/29) More States Weigh Curbs on Private-Equity Healthcare Investments – Statehouses are flooded with proposals to regulate private-equity healthcare mergers, as lawmakers begin their 2025 legislative sessions with renewed efforts to check corporate consolidation in the medical sector. At least six state legislatures have introduced bills in the past two weeks to curtail—or demand more information about—corporate healthcare mergers, with several of the measures specifically targeting private-equity transactions, according to an analysis of the new proposals by law firm Holland & Knight.

Milbank Memorial Fund (1/28) A Menu of State Choices for Addressing Unaffordable Growth in Hospital Commercial Prices – States can pursue a series of smaller-scope and more targeted policies if the other six strategies cited in this brief are not feasible at a given time. These strategies are likely to have less financial impact than most of the more systemic approaches. Two examples follow:

• Ban anti-competitive contracting: State oversight of provider consolidation focuses primarily on preventing horizontal consolidation (between the same type of organization, e.g., hospitals) and vertical consolidation (across different types of organizations, e.g., hospitals and physician practices) that can make markets less competitive and raise provider prices.
• Implement site-neutral payments: Many routine health care services are safely provided in both hospital outpatient departments and in nonhospital settings, such as physician offices.

Brown University (1/28) More primary care physicians are affiliated with hospitals, leading to increased patient costs – A study by researchers at the Brown University School of Public Health shows that nearly half of all primary care providers (PCPs) in the United States are affiliated with hospitals, while the number of PCPs affiliated with private equity firms is growing and concentrated in certain regional markets. Health care consolidation is a driving force behind high health care prices in the U.S., said lead study author Yashaswini Singh, an assistant professor of health services, policy and practice who is affiliated with the Center for Advancing Health Policy through Research at Brown.

Events

• February 24-28, 2025 – Health Care Value Week, “Health Care Value Week 2025.”

March

• March 11, 2025 – Primary Care for America, “Medicare’s Impact on Primary Care.”

If you would like your event to be included in the next newsletter, please email sarah@physiciansforvalue.org