|
News Clips
Health Affairs (9/5) Out Of Balance: Fixing Our Health System’s Neglect Of Primary Care – To bring balance to the US health care system, Congress would do well to heed the NASEM report’s recommendation to restore the Relative Value Scale Update Committee (RUC) to its originally intended advisory nature “by developing and relying on an additional HHS-based independent expert panel and evidence derived directly from practices.” Such experts, who should be practitioners without financial conflicts, could develop and apply broader standards for the economic and social value of clinician services than the RUC currently does. The Senate Finance Committee RFI and recent bipartisan legislative proposals offer opportunities for critically important progress in each of the policy areas discussed in this article.
Health Affairs (9/5) The Failing Experiment Of Primary Care As A For-Profit Enterprise – Despite what might appear to be the unattractive business model of primary care, recent years have seen a slew of acquisitions of primary care practices by large, investor-owned corporations. Private equity, which once shunned primary care in preference for more lucrative specialty practices, is also now accelerating the purchase of primary care practices. What are we to make of this new-found enthusiasm among investors and large corporations for primary care? Are they enlightened saviors of primary care, appreciating the need to invest capital in primary care to achieve a high-value health system? Or are they mainly eyeing primary care as an opportunity for extractive financial gains? This article discusses the rapid waxing and, of late, waning of corporate investment in primary care, arguing that recent events are quickly dispelling hopes of these interests rescuing primary care.
Health Affairs (9/9) The Rise Of Health Care Consolidation And What To Do About It – The growth in consolidation over the years has led to less competition, which in turn comes with higher prices and significant economic impacts, declines in affordability and access, and decreases or stagnation in quality for patients. To blunt incentives for, and cost-increases from, vertical consolidation, policy makers at the federal and state levels should expand site-neutral payment policy within Medicare, and beyond that program to commercial insurance markets. Medicare has taken limited steps toward payment reform that would pay the same rate for the same service, regardless of where it is provided, referred to as “site-neutral payment.” The Medicare Payment Advisory Commission and others have argued for expansion of Medicare’s site-neutral payment policy to all off-campus physician offices owned by hospitals and to eliminate the exception for grandfathered locations.
JAMA (9/17) Outcomes by Race and Ethnicity Following a Medicare Bundled Payment Program for Joint Replacement – The Comprehensive Care for Joint Replacement (CJR) model, a traditional Medicare bundled payment program for lower-extremity joint replacement, is associated with care for patients outside traditional Medicare. Whether CJR model outcomes have differed by patient race or ethnicity outside of traditional Medicare is unclear. This cohort study shows that CJR program outcomes differed by race and ethnicity for patients covered outside traditional Medicare, with home discharge rates increasing more for Hispanic compared with non-Hispanic White patients. These findings suggest the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups.
Health Affairs (9/16) Strengthening Primary Care Reimbursement Models To Improve Medicare’s Outcomes And Efficiency – On a national level, policymakers are acknowledging the challenges that patients face as they seek primary care. The Senate Finance Committee and other leaders have recently proposed major changes to how we support and fund primary care—especially in Medicare, the nation’s most influential payer. CMS Innovation Center is now accepting applications for its newest model, ACO Primary Care (PC) Flex, which offers practices flexibility in delivering primary care by combining fee-for-service (FFS) and prospective payment elements starting in January 2025. These efforts have two things in common: They seek to invest more in primary care, and they provide a new payment structure that gives the primary care community more stability and flexibility to re-establish its role in the health care system. These fundamental changes in how and how much primary care is paid are critical to ensuring our health care system makes the crucial operational and workflow changes needed to how we deliver care—especially the kind of robust primary care that keeps people healthy and manages chronic conditions while lowering costs.
Modern Healthcare (9/16) How hospitals can prepare for TEAM bundled payments – Hospitals are in countdown mode for a new mandatory Medicare bundled payment model, and there’s lots left to do. As part of the 2025 reimbursement rule for inpatient hospitals, the Centers for Medicare and Medicaid Services finalized a payment experiment called the Transforming Episode Accountability Model, or TEAM, which establishes episode-based payments for lower-extremity joint replacements, femur fracture surgeries, spinal fusions, coronary artery bypass grafts and major bowel procedures at nearly 700 hospitals. About one-quarter of hospitals will participate in TEAM, which CMS determined through a formula that accounts for geography, average spending and participation in previous payment models. The five-year demonstration begins in 2026, but industry experts say hospitals have to carry out myriad tasks to be ready, such as running claims data analyses and restructuring care design in partnership with post-acute care providers.
Healthcare Innovation (9/18) Bringing PREMs and PROMs Into Value-Based Care – During a Sept. 17 panel discussion, Susannah Bernheim, chief quality officer and acting chief medical officer with the CMS Innovation Center, described how CMS alternative payment models are evolving to include patient-reported measures. Bernheim was speaking at an Agency for Healthcare Research & Quality meeting about bringing patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) into value-based care. “We fundamentally believe that bringing patient-reported measures into the model will let us know which improvements matter to beneficiaries,” Bernheim added. “We’re amplifying the voice of patients, helping to drive innovations in care that we hope will increase the likelihood that people receive care aligned with their own goals.”
Health Affairs (9/18) The Promise And Pitfalls Of Site-Neutral Payments In Medicare – From 2021 to 2022, Medicare spending increased by 5.9 percent, from $689 billion in 2021 to $944 billion in 2022, reaching 21 percent of total National Health Expenditures. Increased Medicare spending has raised concerns about the financial sustainability of the Medicare program. As health care spending has increased over the last decade, bipartisan momentum to address health care costs has emerged. Site-neutral payments in Medicare have emerged as a potential policy option to reduce Medicare spending without impacting beneficiaries' access and quality of care. This option has gained support from many across the health care industry, including former HHS secretaries Alex Azar and Kathleen Sebelius, who co-authored a joint op-ed
in STAT to support the adoption of site-neutral payments for health care. This Forefront article discusses reasons leading to the support of site-neutral payment policies and the current and future steps that are required to fill the current gaps and address the concerns surrounding it.
|
