This Week in Physician-Led Care

September 19 to September 30, 2020

The Partnership to Empower Physician-Led Care is proud to present the new format of our weekly newsletter, which includes news from our members, legislative and Administration updates, as well as news clips about value-based care, primary care, and independent physicians. 

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Administrative Updates

HHS: (9/29) – HHS launched an initiative to measure health IT use among office-based physicians. HHS ONC awarded a cooperative agreement to the American Board of Family Medicine to measure the use and potential burdens experienced by office-based physicians to provide national-level data on how physicians use health IT.

ONC: (9/27) – HHS ONC announced four awards under the Leading Edge Acceleration Projects in Health Information Technology (LEAP in Health IT) funding opportunity. The awards, which total $2.7 million, will support awardees in testing data sharing functionalities to support clinical care, research, and improved outcomes.

White House: (9/24) – As part of his America First Healthcare Agenda, President Trump committed to improving access to direct primary care arrangements that enable patients to spend more time with their doctors.

CMS: (9/24) – CMS announced the Calendar Year (CY) 2021 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model and information about the CY 2022 application process for eligible MA organizations. Fact sheet, Information

CMS: (9/22) – CMS released an evaluation report of the first three years of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The report finds that VBID has not yet led to significant changes in costs to Medicare or plans. VBID was associated with increased use of many high-value services targeted by Parent Organizations such as PCP visits, specialist visits for targeted conditions, and 30-day drug refills. VBID was also associated with reduced Part D bids. Two-pager, Report Perspective, Report Information

Legislative Updates

Continuing Appropriations Act, 2021: (9/22) – The House passed by a 359-57 vote the Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8337), a bipartisan continuing resolution to extend federal government funding, including health extenders through December 11. Press release, Section-by-section

Competitive Health Insurance Reform Act of 2019: (9/21) –The House passed by voice vote the Competitive Health Insurance Reform Act of 2019 (H.R. 1418), which would restore the application of the federal antitrust laws to the business of health insurance to protect competition and consumers. The bill now moves to the Senate for consideration.

Member News

California Medical Association: (9/28) – In CMA’s Physician Financial Health Survey, physician practices reported an average 64 percent decline in revenue, with 95 percent of respondents worried about their financial health and ability to remain in practice. CMA is currently doing an advocacy campaign to urge Congress to oppose cutting Medicare payments during the COVID-19 pandemic.

Aledade: (9/23) – Aledade, Inc. announced its accountable care organizations with commercial payers, Medicaid, Medicare Advantage, and the Medicare Shared Savings Program saved more than $400 million across the health care system in 5 years, with over half of that value created in the past year. 

Aledade: (9/21) – Aledade, Inc. and MGMA hosted a webinar on the future of reimbursement, providing a framework for understanding the financial, clinical, and operational implications of COVID-19 and how to best position physician practices for success by embracing accountability for patient outcomes in value-based care models.

News Clips

Revcycle Intelligence: (9/28) – A report from Insights by Xtelligent Healthcare Media revealed that private payers are more likely than public payers to participate in value-based reimbursement models. Public payers were less likely to be involved in heavy, risk-based reimbursement models compared to private plans, despite knowing the impact VBC would have on their organization’s financial health.

Fierce Healthcare: (9/28) – With the future of the ACA at the center of the new SCOTUS pick, experts are chiming in about how VBC could be impacted should the ACA be struck down. VBC will likely be safe, largely due to efforts by private payers to accelerate adoption of VBC in recent years.

OSHPD: (9/28) – OSHPD awarded 86 primary care residency programs $35 million in grants to expand health care access to Californians most in need. This initiative funds institutions that train primary care health professionals to provide care in medically underserved areas of the state.

Street Insider: (9/28) – In 2019, 75 percent of Premier Population Health Management Collaborative (PHMC) ACOs participating in the MSSP generated savings for Medicare. Of these ACOs, 44 percent performed well enough to qualify for shared savings payments from Medicare.

Delaware Public Media: (9/27) – Delaware is launching four ACOs to serve Medicaid beneficiaries in order to optimize care delivery and eliminate health care disparities in this population. The Delaware Department of Health and Social Services approved Aledade to launch its ACO for Medicaid patients.

Becker’s Healthcare: (9/25) – Following the release of the CMS 2019 results from the Medicare Shared Savings Program ACOs, Becker’s interviewed six executives from ACOs that earned some of the most shared savings to share strategies and best practices that led to positive results.

Benefits Pro: (9/25) – The House passed the Competitive Health Insurance Reform Act (HR1418), which would repeal the McCarran-Ferguson antitrust exemption for health insurance companies and curb the rate of consolidation in the health care industry.

Health Affairs: (9/25) – Health Affairs proposed a new “PPE” - the combined efforts of Public health, Primary care, and Health equity (PPE) – as a means of equipping communities with the tools, plans, and knowledge to thrive and providing a path toward COVID-19 recovery.

Fierce Healthcare: (9/24) – As cold and flu season approaches, primary care practices are experiencing staffing shortages and disruptions to primary care funding as a result of COVID-19. Equipment shortages pose another threat to primary care, as practices reported difficulty obtaining COVID-19 supplies, PPE, and supplies for flu season.

Healthcare Dive: (9/23) – A survey conducted by the Larry A. Green Center and the Primary Care Collaborative found that 35 percent of primary care physicians say revenue and income are still significantly lower than they were prior to COVID-19 and are calling for more federal aid. However, a third of physicians said their financial picture was slowly improving.

ThinkAdvisor: (9/23) - Proposed IRS regulations (REG-109755-19) may have the potential to end HSA-Direct primary care combinations. The regulations define direct primary care as a form of insurance, not a service, meaning it would not satisfy the criteria as a high-deductible plan necessary to qualify for an HSA and would therefore prohibit patients with direct primary care from accessing an HSA.

Revcycle Intelligence: (9/22) – A new survey confirms growing concern among ACOs that many are unlikely to meet rising participation thresholds for MACRA’s Advanced APMs in 2021, with more than 96 percent of ACOs reporting that they would not meet the 2021 thresholds passed on their performance in 2020 and would therefore not receive the incentive payment during the corresponding payment period.

Revcycle Intelligence: (9/21) – The economic fallout and devastating financial losses caused by the COVID-19 pandemic could accelerate acquisitions of independent practices. Shifting to value-based contracts may help independent practices pivot, generate value, and remain independent in the future.

Revcycle Intelligence: (9/21) – CMS finalized two alternative payment models for specialty care – the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Radiation Oncology (RO) Model. These models will alter how specialists in Medicare get paid by tying reimbursement to quality metrics.

Primary Care Collaborative: (9/21) – A new report from Milbank provides insight for designing prospective payment for primary care and payment design considerations.

Modern Heathcare: (9/19) – Capitated payment models present an opportunity for practices to treat patients in the best way possible while also having a dependable revenue stream when patient visits plummet, like with COVID-19. However, logistical hurdles, regulations, and existing insurance contracts must be considered when entering into these arrangements.

Modern Healthcare: (9/19) – Rep. Dan Crenshaw (R-TX) reflected on the concept of direct primary care as a modern approach to personalized health care. Crenshaw will soon introduce the Direct Primary Care for America Act to expand and normalize access to the direct primary care model.




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