Administrative Updates

CMS: (11/16) — CMS announced that the FY 2020 Medicare FFS estimated improper payment rate was 6.27 percent, representing $25.74 billion in improper payments. Medicare FFS improper payments have declined by an estimated $15 billion since 2016.

HHS & CMS: (11/20) — On November 20, HHS and CMS issued the final Stark and Anti-Kickback statute rules. The two final rules aim to reduce regulatory barriers to care coordination and accelerate value-based arrangements. The final rules also ease unnecessary compliance burdens for healthcare providers and other stakeholders across the industry. Anti-Kickback Fact sheet Stark Fact sheet Stark Press release AKS Final rule Stark Final rule

HHS: (11/20) — HHS finalized the removal of safe harbor protection for rebates involving prescription pharmaceuticals and creation of new safe harbor protection for certain point-of-sale reductions in price on prescription pharmaceuticals and certain pharmacy benefit manager service fees rule. The rule seeks to eliminate the current system of drug rebates in Medicare Part D, in order to create incentives to lower list prices and reduce out-of-pocket spending on prescription drugs by delivering discounts directly at the pharmacy counter. Fact sheet Final rule

CMS: (11/20) — CMS announced the first cohort of Primary Care First participants, including the 916 primary care practices and 37 regional partnerships with commercial, State, and Medicare Advantage plans partnering across the selected Primary Care First regions.

CMS: (11/20) — CMS announced the Most Favored Nation (MFN) Model, which will test an innovative way for Medicare to pay no more for high cost, physician-administered Medicare Part B drugs than the lowest price charged in other similar countries. CMS also issued a corresponding Interim Final Rule with Comment Period (IFC). The model will operate for seven years, from January 1, 2021 to December 31, 2027. Fact sheet IFC Information

Legislative Updates

Rep. Sherill: (11/16) — Rep. Sherrill (D-NJ) and 13 cosponsors introduced the bipartisan Expanded Telehealth Access Act (H.R. 8755), which would expand the scope of practitioners eligible for payment for telehealth services under the Medicare program.

Member News

Aledade: (11/23) — Aledade announced that its Kansas physician-led ACOs, in collaboration with Blue Cross and Blue Shield of Kansas, helped 25 primary care practices across the state lower costs by improving quality of care.

Aledade: (11/23) — Farzad Mostashari, CEO of Aledade, highlights the results from the 2019 Medicare Shared Savings Program and data from contracts with commercial and other payers highlight how well the Aledade model works by improving quality while lowering costs. Mostashari highlights that over the last five years, Aledade ACOs have saved the health care system more than $400 million by rewarding physicians for delivering quality care.

Healthcare Finance: (11/20) — A group of 19 health care organizations, including Aledade, MGMA, American Academy of Family Physicians, co-signed a letter sent to Congressional leaders supporting legislation freezing the current thresholds for incentive payments at the current rate for the 2021 and 2022 performance year to ensure that providers participating in risk-bearing alternative payment models get their bonuses and to encourage new participation. 

Modern Healthcare: (11/20) — Provider groups are skeptical on the recent finalization of the Stark and Anti-Kickback rules, with MGMA Associate Director of Government Affairs Mollie Gelburd noting that without uniform rules, it will be difficult to bring all the changes into line with value-based arrangements that exist in the real world, as many groups may not actually be able to use the full-risk exception.

News Clips

Center for Health Care Strategies, Inc: (11/24) - Defining how Medicaid managed care organizations can best support advanced primary care can be challenging despite state Medicaid agencies’ desire to support advanced primary care models. CHCS developed a toolkit in partnership with the Commonwealth Fund to help states use their managed care purchasing authority to advance innovations in primary care.

Healthcare Innovation Group: (11/23) — The ACO landscape has been seen as a key step in redesigning the health care system. Success in ACO models takes a commitment to achieving physician buy-in and investments in technology infrastructure, among other things. This article explores some of the keys to success for ACO models and the importance of buy-in across the system.

PR Newswire: (11/23) - Signify recently acquired PatientBlox to accelerate its prospective provider payment capabilities for episodes of care. This move is supporting the company’s commitment to advance value-based care through novel payment and risk arrangements.

Fierce Healthcare: (11/23) — The Trump administration finalized the changes to the Stark and Anti-Kickback laws on Friday, drawing mixed reviews from stakeholders. Hospital groups like the American Hospital Association and the Federation of American Hospitals were optimistic about the changes, while physician groups like the American Medical Group Association (AMGA) expressed skepticism. AMGA noted that while the final rules demonstrate a willingness to help providers move towards value-based care, the risk requirements will still make the path to value difficult, even at a lower rate.

Healthcare Innovation: (11/23) - CMS recently released a list of participants for its Primary Care First model, a multi-payer APM that will be offered in 26 regions beginning in 2021. Payer partners have signed up to participate in every region except Hawaii and include payers such as Humana and Aetna.

Today Online: (11/20) — Independent and small practice physicians are retiring early or leaving their jobs due to the COVID-19 pandemic, as financial, safety, and mental health pressures have amplified problems that they were already facing.

Revcycle Intelligence: (11/19) - AMGA sent a letter urging Congress to provide new funding for the Provider Relief Fund to restart the Medicare Accelerated and Advanced Payments program. Rising COVID-19 cases was cited as a reason necessitating additional financial assistance, as many patients will need to delay or cancel elective procedures and an increase in cases will further strain health systems.

Fierce Healthcare: (11/19) - A survey by the Larry A. Green Center revealed that over one-third of physicians said patients with chronic conditions are in worse health as a result of the pandemic, with mental health particularly declining for patients in the last eight months. About 56 percent of physicians reported an increase in negative health burdens due to delayed or inaccessible care during the pandemic.

Revcycle Intelligence: (11/18) — New analysis in Health Affairs found that in an assessment of over a dozen CMS initiatives over the past 8 years, the population-based alternative payment models, like ACOs, saved Medicare the most money.

Becker’s ASC: (11/17) — U.S. physicians are increasingly concerned about finances during the COVID-19 crisis. A three-part survey from McKinsey & Co. found that 52 percent of small, independent practices were concerned about making it through COVID-19.

Events

November

• November 25, Aledade, “Making Telehealth and In-Person Care Work for Primary Care Long-Term.” Virtual.
  
• November 30-December 1, Primary Care Collaborative, “Crisis As Catalyst: Reimagining Primary Care.” Virtual Annual Conference.
  

December

• December 2, Partnership to Empower Physician-Led Care, "Virtual Briefing: Examining Proposals to Increase Health Care Competition.” Virtual.
• December 2, Primary Care Collaborative, “Primary Care Investment 2.0: State Innovation Workshop.” Virtual.
• December 2, Manatt, “Next-Generation Strategies to Transform Pediatric Primary Care.” Virtual
• December 3, Fierce Healthcare, “Financial Outlook for Physicians for 2021.” Virtual.
• December 7, Manatt, “Medicaid Managed Care Payment Policies to Support Pediatric Providers.” Virtual. 
• December 9, Aledade, “Why You Should Join an ACO with Primary Care First and Considerations for CPC+ Practices.” Virtual.
• December 10, Modern Healthcare, “Webinar: Leveraging Lab Analytics for Success in Value-Based Care.” Virtual.

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