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News Clips
Health Affairs (8/6) Closing The Gap In Value-Based Care: Lessons From Provider-Led ACO Experience – ACOs require a substantial upfront investment to meet administrative and reporting requirements. This challenge is compounded by the timing of settlements for shared savings/losses, which take place months after the conclusion of a performance year. This impacts ACOs’ ability to pay providers and care teams in a timely fashion or can disincentivize participation altogether. Furthermore, this leaves ACOs at a disadvantage unless they are well-capitalized, limiting the opportunity for smaller provider organizations to participate. This article proposes four pillars to close the gap: full risk-sharing options for ACOs, upfront capitated payments, financial predictability, and sustainable payment formulas.
Medical Economics (8/5) Can independent practices stay afloat amid waves of industry consolidation? – The days of independent primary care practices, once a bedrock in the communities they served, are rapidly fading. Like many aspects of the health care industry in the United States, consolidation is making fundamental changes to what primary care looks like now and how it will function in the future. Larger corporate entities are buying up more and more independent practices, be they hospitals, health systems, insurers, private equity groups or even larger medical practices. Primary care practices are especially valuable because they can direct patients to in-system specialists and services. However, as small practices are absorbed, there are concerns about the potential loss of personalized care and the erosion of the physician-patient relationship, and many of the supposed benefits of consolidation have proved elusive. Prices don’t always come down, quality of care doesn’t always increase, and the administrative burden on physicians is as cumbersome as ever.
JAMA (8/2) Quality-of-Care Outcomes in Vertical Relationships Between Physicians and Health Systems – In this study, vertical relationships between primary care physicians (PCPs) and large health systems were associated with patient steering and changes in care delivery processes, but not necessarily improvements in patient outcomes. One potential explanation for these results is the context in which consolidation occurs, namely the underlying incentives of fee-for-service payment. Quality-of-care changes can be revenue-losing, revenue-neutral, or revenue-generating, and these distinctions may explain the pattern of observed changes. The low-value care services examined are revenue-generating, and because the fee-for-service incentives are unchanged through vertical consolidation, this could be a reason we do not observe changes in the outcome. While admissions and ED visits are costly to the patient and payers, health systems with hospitals are not penalized for such utilization, unless they are part of a contract that is structured to significantly disincentivize avoidable admissions and ED visits.
Health Affairs (8/1) Advancing Equity In Kidney Transplantation Through The Increasing Organ Transplant Access Model – On May 8, 2024, CMS proposed the Increasing Organ Transplant Access (IOTA) model: a six-year mandatory payment model designed to expand equitable access to kidney transplantation—the preferred treatment option for kidney failure (that is, end-stage renal disease [ESRD]) over dialysis given the higher survival rates and quality of life at lower costs.This article briefly summarizes the proposed IOTA model, describe how CMS’s health-equity strategies have evolved from the ETC model to the IOTA model, and highlight potential challenges and opportunities that may impact inequities in kidney transplantation.
JAMA (7/30) Hospital Assets Before and After Private Equity Acquisition – Private equity firms spent $505 billion on health care acquisitions between 2018 and 2023. This study assessed changes in hospitals’ capital assets after private equity acquisition. After private equity acquisition, hospital assets decreased by 24 percent relative to that of controls during two years. Private equity acquisitions appear to have depleted, rather than augmented, hospital assets. Although funds from asset drawdowns might be redeployed to enhance care or efficiency, previous studies suggest such effects may not occur. Financial outcome of private equity hospital acquisitions and effects on patient care require further study.
Health Affairs (7/30) State And Federal Efforts To Improve Ownership Transparency – The lack of good data on ownership and control limits the ability of policy makers to target policies aimed at lowering prices, encouraging competition, and improving quality. It also hinders researchers’ ability to study the impacts of various types of ownership and controlling interests on health care markets. While transparency alone is insufficient to mitigate price increases and other harms from growing consolidation in health care markets, it forms a crucial foundation for further action. This article reviews recent ownership transparency efforts at the federal level and in two example states: Indiana and Massachusetts. It further explores how Massachusetts is applying lessons from Steward to strengthen its long-standing provider transparency programs in light of increasingly obscure ownership structures and controlling interests.
The Tennessean (7/29) Opinion: Independent physicians provide patients a personal touch missing in large hospitals – As a physician in private practice, I've been called a throwback. Most doctors today work for large hospitals or health systems. That's not my vision, nor do I think it's the future of medicine. My partners and I see our oncology practice as an example of how to provide patient-focused care built on deeper, more trusting doctor-patient relationships than conglomerates can offer. Achieving that vision requires outside financial support and help dealing with the complexities of modern health care. Five years ago, my practice enlisted the help of a management services organization (MSO) to bring cutting-edge technology into our practice and build a sustainable future that allows us to see every patient, including those with TennCare or no insurance.
STAT (7/25) How UnitedHealth harnesses its physician empire to squeeze profits out of patients – By controlling doctors, UnitedHealth can lean on them to practice in ways that benefit the insurer, and use its insurance arm to funnel cash back to its clinicians. Through these efforts, and by adeptly navigating the Medicare Advantage payment system, UnitedHealth has squeezed potentially tens of billions of extra dollars from taxpayers over the past decade, according to STAT estimations based on federal data. The relationship between UnitedHealth’s insurance company and physician practices is the focus of an ongoing Department of Justice antitrust probe. UnitedHealth has required some physicians to see as many as four patients per hour, a difficult task if any of those patients are new to a clinic, they said. Patients, meanwhile, are wondering why their doctors are rushing through their appointments — if they can get seen at all — and have expressed alarm when concerning diagnoses pop up in their medical records, many of which were never mentioned by their physicians.
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