Welcome to this week's edition of the 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.
HHS: (3/2) - HHS announced additional Biden-Harris Administration appointments, building on an experienced team committed to President Biden’s mission to end the COVID-19 pandemic, expand affordable health care, and advance equity.
CMS: (3/1) - CMS updated the webpage for the Geographic Direct Contracting Model, announcing the model was currently under review and that CMMI would share more information once it becomes available.
CMS: (2/26) - CMS announced it will accept letters of intent to apply to the Medicare Shared Savings Program in early June. Applications are due June 28, and August 3 is the last chance to add ACO participants. The agreement start date will be January 1, 2022 to provide ACOs with additional time to submit application materials and resolve deficiencies.
White House: (2/24) - President Biden issued a notice continuing the national emergency concerning the COVID-19 pandemic beyond March 1, 2021.Letter
White House: (2/24) - President Biden signed an Executive Order (EO) on Securing America’s Critical Supply Chains, to create more resilient and secure supply chains for critical and essential goods. The Executive Order launches a comprehensive review of U.S. supply chains and directs federal Departments and Agencies to identify ways to secure U.S. supply chains against a wide range of risks and vulnerabilities.Fact sheet
White House: (2/24) - President Biden announced new actions to deliver masks to communities hit hard by the pandemic. The Administration will deliver more than 25 million masks to over 1,300 Community Health Centers across the country as well as 60,000 food pantries and soup kitchens, reaching some of the nation’s most vulnerable populations.
COVID-19 Hospital and Health Provider Loan Conversion Act: (2/25) - Rep. Kaptur (D-OH) and 12 bipartisan cosponsors introduced the COVID-19 Hospital and Health Provider Loan Conversion Act (H.R. 1349), which would provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program.
Coronavirus Medicaid Response Act: (2/25) - Rep. Lee (D-NV) and 48 cosponsors introduced the Coronavirus Medicaid Response Act (H.R. 1353), which would increase Federal support to State Medicaid programs during economic downturns. Sen. Casey (D-PA) and 22 cosponsors introduced companion legislation in the Senate (S. 439).One-pager
Crush the Virus Act: (2/25) - Rep. Reed (R-NY) introduced the Crush The Virus Act (H.R. 1371), which would make supplemental appropriations for the fiscal year ending September 30, 2021, providing coronavirus emergency response and relief.
Medicare-X Choice Act:(2/23) - Reps. Delgado (D-NY), Higgins (D-NY) and Larson (D-CT) introduced the Medicare-X Choice Act (H.R. 1227), which would establish a public health plan. Sens. Bennet (D-CO) and 12 cosponsors introduced companion legislation in the Senate (S. 386). Summary
IMPACT To Save Moms Act: (2/22) - Sens. Casey (D-PA), Menendez (D-NJ), and Booker (D-NJ) introduced Innovative Maternal Payment and Coverage To (IMPACT) Save Moms Act (S. 334), which would establish an alternative payment model demonstration project for maternity care provided to pregnant and postpartum individuals under State Medicaid and CHIP programs.
MGMA:(3/1) - MGMA submitted written testimony for the House Energy & Commerce Committee hearing on the future of telehealth and how COVID is changing the delivery of virtual care. In the letter, MGMA stated its support of congressional efforts to ensure Medicare beneficiaries have greater access to telehealth services but would like future legislation to take into account the importance of the patient-physician relationship. The letter includes several policy recommendations for the committee to improve such services moving forward.
STAT: (2/26) - Aledade CEO Farzad Mostashari and CMO Emily Maxson wrote an op-ed highlighting how President Biden’s American Rescue Plan aims to correct an oversight by the previous administration’s vaccine planning by including primary care offices in the COVID-19 vaccination effort. Given the important role primary care providers play in vaccination and in fostering trusted relationships with patients, Mostashari and Maxson make the case for how the Plan can leverage primary care providers in the vaccine distribution strategy and expand the CDC’s Vaccine Tracking System access directly to primary care offices willing to vaccinate their patients.
Aledade: (2/24) - On February 24, Aledade held a webinar on the future of value-based care in the Biden Administration. Discussion included what the Biden Administration’s top priorities would be, the impact such priorities will have on value-based care, how MSSP has survived administration transitions and how best practices can be applied, and what is next for the CMS Innovation Center.
STAT: (3/2) - Former Trump Administration officials revealed that the administration redirected $10 billion in funds meant to support providers through the Provider Relief Fund to be used as part of Operation Warp Speed vaccine efforts. HHS used a financial maneuver that allowed officials to divert the funds without Congress being notified, and it is not currently clear whether the outlay means less money is now available to providers.
Health Affairs: (3/2) - To transform how MassHealth, Massachusetts’ Medicaid program, funds and organizes the delivery of health care to children and their families, the Child and Adolescent Health Initiative (CAHI) developed a roadmap converting established principles for pediatric primary care delivery transformation into specific, actionable reforms the state can adopt in its upcoming renewal of its Medicaid 1115 waiver or other Medicaid authorities.
Health Affairs: (3/2) - The Biden Administration is facing the question of what to do with the Merit-Based Incentive Payment System (MIPS), which has drawn criticism over the years because of design flaws and unintended consequences resulting from them. Rather than eliminate MIPS, this article calls for transforming MIPS by aligning it as closely as possible with APMs. Transforming MIPS should involve three steps: couple clinicians’ performance in the Quality and Cost domains; revise financial rewards to better reflect APM incentives; and redesign MIPS to move clinicians through the program in a more explicit, predictable fashion.
Becker’s Hospital Review: (3/1) - CMS updated its Quality Payment Program - COVID-19 Response FAQ to implement an automatic extreme and uncontrollable circumstances policy for some clinicians participating in the Quality Payment Program’s Merit-based Incentive Payment System. The exception is due to the ongoing pandemic and only applies to physicians participating as individuals for the 2020 performance period.
Medscape: (3/1) - A Health Services Research study of Medicare claims data from 2010 to 2016 found that physician payments for services billed by a hospital were $114,000 higher on average each year compared to services billed by an independent practice physician. The study also found that Medicare revenue for outpatient services billed by physician offices would have been 80 percent higher if billed by a hospital outpatient department. Payment differences exhibited a modest positive relationship to hospital-physician vertical integration, particularly among primary care physicians.
Healthcare Dive: (3/1) - Elizabeth Fowler was officially announced to be the new director of the CMS Innovation Center and began her new role this week. Fowler has a long background in health policy and will direct CMMI’s efforts to develop new payment models focused on value-based care.
Becker’s Hospital Review: (3/1) - A recent study by RAND Corporation, published in Health Affairs, found that bundled payments lowered total surgery costs for three procedures by a relative reduction of 10.7 percent, or an average of $4,229. Patient cost sharing decreased by $498 per episode (27.7 percent) and employers captured $3,582 in savings per episode (85 percent).
Modern Healthcare: (2/26) - Chapters Health System has embraced the movement to community-based care delivery as a way to solve issues in the current fragmented health care delivery system. Cultural and operational underpinnings rooted in individualized care planning have set the stage to incorporate community health services, social determinants of health, and primary care in value-based designs. Chapters Health has used its continuum-based approach to focus on the needs of each patient and the unique pain points of each payor to employ solutions that bring maximal return.
MedCity News: (2/26) - Mercy and Humana have partnered to expand access to virtual health resources to Humana Medicare Advantage members who are patients at Mercy facilities and provide physician practices with in-network access to Mercy Virtual. The agreement will include offering virtual primary care and will also link provider reimbursement to quality of care to shift to value-based compensation.
Fierce Healthcare:(2/25) - A survey of 485 physicians and administrators by Jackson Physician Search found that 83 percent of physicians reported their employer had no physician retention program in place, while 30 percent of administrators reported the same. The survey highlights the impact of the COVID-19 pandemic on physician retention and that a large number of providers have considered retiring early, leaving to work for a different employer, or leaving the practice of medicine entirely. The survey also outlines recommendations for addressing physician turnover and retention rates.
The Charlotte Observer: (2/25) - Tryon Medical Partners, the largest independent practice in Charlotte, NC, will receive between 100 and 200 doses of the COVID vaccine this week. CEO Dr. Dale Owen claimed this is not enough, and that primary care physicians have largely been left out of the state’s vaccine rollout. Many patients, especially older patients, have expressed a preference to receive the vaccine from their primary care provider, a sentiment that is especially true for patients who have difficulty signing up for a vaccine appointment through the internet with a new doctor or health system.
MedCity News:(2/24) - President Biden recently announced his pick of Chiquita Brooks-LaSure to lead CMS. If confirmed, one of Brooks-LaSure’s top priorities will likely be expanding access to health care coverage and focusing on health equity, especially as it relates to improving quality.
The National Law Review: (2/24) - The COVID-19 pandemic has marked a renewed focus on value-based care. This article outlines five trends to watch in 2021, including: leaning in to value-based care; continued innovation and disruption; capitalizing on COVID-19 infrastructure; new opportunities for provider alignment; and emphasis on social determinants of health.
Committee for a Responsible Federal Budget: (2/23) - As part of the Health Savers Initiative, the Committee for a Responsible Federal Budget, Arnold Ventures, and West Health published three policy briefs outlining proposals to reduce health care costs. The first three briefs focus specifically on Medicare costs, including a brief on equalizing Medicare payments regardless of site-of-care. This particular brief addresses how Medicare payments for similar procedures vary based on site-of-service, which incents provider consolidation and drives up costs. A site-neutral payment policy could reduce Medicare spending by $153 billion over the next decade and reduce premiums and cost-sharing for beneficiaries by $94 billion, among other savings in the private sector.
Commonwealth Fund: (2/23) - In this article, the authors outline how current measures to evaluate Medicare savings proposals fall short and call for a broader lens when weighing options. As such, Health Management Associates, with support from the Commonwealth Fund, created a comprehensive assessment tool to evaluate Medicare savings policies across a range of budgetary, beneficiary, and health system measures.