Welcome to 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.
2023 Omnibus Appropriations Bill
Consolidated Appropriations Act, 2023: (12/29) – President Biden signed the Fiscal Year 2023 Consolidated Appropriations Act into law. As previously reported, the legislation includes appropriations for fiscal year 2023 and several key health care extenders and new authorizations, including extending the alternative payment model (APM) bonus for one year at a rate of 3.5 percent and reducing Medicare physician payments by two percent in 2023 and 3.25 percent in 2024. This is a slight relief from the 4.5 percent reduction physicians were facing. Bill Text
California Medical Association: (12/26) – The California Medical Association (CMA) released a statement on the year-end omnibus legislation, which includes a Medicare physician payment cut of 2.5 percent in 2023. CMA is urging Congress to immediately get to work on a long-term overhaul of the Medicare payment system that includes an annual automatic inflation update, addresses budget neutrality, and provides more alternative payment model opportunities.
American Academy of Family Physicians: (12/23) – The American Academy of Family Physicians (AAFP) released a statement on the year-end omnibus legislation, expressing disappointment in the Medicare physician payment cuts in 2023. “Coupled with inflation and rising practice costs, any payment cut puts untenable strain on family medicine and other physician practices. This ultimately worsens beneficiaries’ timely access to care, stalls progress toward value-based care and hastens health care consolidation. Congress must take action to ensure Medicare physician payment policies support comprehensive and continuous primary care, keep pace with increasing practice costs and stop the annual threat of Medicare cuts.”
Other Policy News
Sens. Markey (D-MA) and Warren (D-MA): (12/22) – Sens. Markey (D-MA) and Warren (D-MA), along with eight Representatives, sent a letter to HHS Secretary Becerra voicing concern on barriers patients are facing in accessing health care as a result of closures, service reductions, mergers, and for-profit acquisitions of hospitals. The letter requests information by January 15 on what data HHS gathers related to hospital closures, service reductions, or mergers or acquisitions due to financial distress. Letter
National All-Payer Claims Database Act: (12/22) – Rep. Beyer (D-VA) introduced the National All-Payer Claims Database Act (H.R. 9644), which would award a contract to an eligible nonprofit entity to establish and maintain a health care claims database for purposes of lowering Americans' health care costs. Bill Text
CMS: (12/21) – CMS released the evaluation for the first three years of the Maryland Total Cost of Care Model. The report found that from 2019 to 2021, the model reduced rates of all-cause acute care hospital admissions and total Medicare spending, and improved several quality-of-care measures. Two-Page Summary
Aledade: (1/4) – Aledade rereleased a white paper, "Transitional Care Management: How ACOs Are Getting Patients into the Doctor's Office and Out of the Hospital," which includes quantitative and qualitative data gathered from primary care practices, best practices on outreach to patients and provision of TCM, and policy recommendations based on the barriers the primary care organizations in our ACOs have identified.
Heritage Foundation: Time for Action To Reverse Hospital Consolidation (1/3) – Independent medical practice, the cradle of the traditional doctor-patient relationship, is rapidly disappearing. Congress can take three big steps to open hospital markets and improving patient access to more affordable and higher quality care. First, Congress can repeal legal restrictions on Medicare and Medicaid payments to physician-owned hospitals. Second, Congress can make Medicare payment for medical services “site neutral. Finally, Congress can codify the federal hospital price transparency rules. Congress should focus on healing dysfunctional hospital markets in 2023.
Modern Healthcare: ER doctors call private equity staffing practices illegal and seek to ban them (12/30) – A group of emergency physicians and consumer advocates in multiple states are pushing for stiffer enforcement of decades-old statutes that prohibit the ownership of medical practices by corporations not owned by licensed doctors. Thirty-three states plus the District of Columbia have rules on their books against the so-called corporate practice of medicine. But over the years, critics say, companies have successfully sidestepped bans on owning medical practices by buying or establishing local staffing groups that are nominally owned by doctors and restricting the physicians’ authority so they have no direct control. The California Medical Association supports the lawsuit, saying it “will shape the boundaries of California’s prohibition on the corporate practice of medicine.”
JAMA: Cost-Sharing Reform for Chronic Disease Treatments as a Strategy to Improve Health Care Equity and Value in the US (12/29) – High-value care can be improved and long-term medical costs reduced by substantive cost-sharing reform. We suggest three concrete policy steps to achieve this goal. First, the Medicare Advantage Value-Based Insurance Design (VBID) model should be expanded to include cost-effective medications used to treat chronic conditions and to include fee-for-service (FFS) Medicare beneficiaries. Second, value-based payment contracts should be designed to limit out-of-pocket costs for cost-effective preventive medications, and public should be allowed to negotiate prices for pharmaceuticals. Finally, payers should consider options to use reference pricing for pharmaceuticals, wherein the least expensive medication among a set of treatment alternatives is offered at no cost to patients and more expensive options have somewhat higher cost sharing.
JAMA: Performance of Physician Groups and Hospitals Participating in Bundled Payments Among Medicare Beneficiaries (12/29) – In this cohort study, participation of physician group practices and hospitals in the Bundled Payments for Care Improvement (BPCI) Initiative was associated with cost savings for surgical episodes; however, only hospital participation was associated with cost savings for medical episodes. Hospital and physician group practice participation were associated with different patterns of changes in post-acute utilization and mortality. These findings underscore the benefit of engaging physician group practices in episode-based payment models. Although it is only one aspect of a payment model’s success, spending reductions are critical because policy makers increasingly judge the viability of bundled payment programs by their cost savings.
STAT: How value-based payments to clinicians can help close equity gaps (12/28) – The U.S. health system has been evolving over the past decade to focus on the quality and value of care. Until recently, though, value-based payment models have not explicitly addressed longstanding racial and ethnic inequities in care. This month, Blue Cross Blue Shield of Massachusetts, the not-for-profit health plan I lead, introduced a value-based payment model that will reward clinicians for closing equity gaps, starting with areas including colorectal cancer screening, blood pressure control, and diabetes care. Four of the largest health systems in Massachusetts have signed these contracts, the first of their kind. We will be sharing our methods and learnings to support other payers across the U.S. that are eager to contribute to a more equitable health system.
Healthcare Innovation: Year in Review: Value-Based Care and Alternative Payment Models (12/28) – In the world of value-based care and alternative payment models, 2022 has seen a heightened focus on health equity. In March, Dora Hughes, M.D., M.P.H., chief medical officer at the CMS Innovation Center, said the Innovation Center’s 10-year anniversary was a good time to look both back and forward at how its models impact health equity and how the organization can do a better job of measuring the models’ impact. In advancing health equity, Hughes described four main areas of focus. The second area of focus is the recruitment of safety net providers, including Federally Qualified Health Centers, rural health clinics, and behavioral health clinics. The third area is an enhanced focus on evaluation.
Modern Healthcare: Staying independent in a consolidated hospital sector (12/28) – More hospitals and health systems are turning to partnerships as an alternative to mergers and acquisitions. The pressure to consolidate has mounted as median days cash on hand decreased by 23 percent year-over-year as of August, according to an analysis of approximately 700 nonprofit hospitals by consulting firm Kaufman Hall. But some health systems have found that partnerships can provide similar benefits to merger and acquisitions without a change in control and increasing operational complexity. Growing regulatory scrutiny of hospital consolidation among the Federal Trade Commission and state attorneys general has also deterred mergers, said Neil Olderman, a partner at law firm Faegre Drinker Biddle & Reath who specializes in health care transactions.
Becker's Hospital Review: 3 letters will make or break health system growth in 2023 (12/27) – The Department of Justice and Federal Trade Commission have been extraordinarily active in challenging mergers and acquisitions under the Biden administration. The FTC is not only active, but also embracing the gray. In November, the agency announced it will expand its interpretation of a 1914 statute that could allow the agency to increase its intervention and legal challenges against what it deems anticompetitive corporate behavior. While the FTC is poised for another active year ahead, lawmakers are looking to another governmental agency — HHS — to gauge its involvement in hospital closures and consolidation. A group of Massachusetts lawmakers requested information from HHS by January on the role it plays in monitoring or interfering with less accessible medical care driven by hospital closures, mergers and acquisitions.
Fierce Healthcare: How community-based organizations are taking a tech-driven approach to connect health services to social care (12/27) – Social determinants have received a renewed spotlight within the industry as the COVID-19 pandemic exacerbated existing health inequities. This has led to social determinants investments as organization take a tech-driven approach to connect patients with the social services they need. Startups focused on the social determinants of health are also attracting big investment dollars as well as spurring M&A deals. Melissa Sherry, vice president of social care integration at Unite Us, argues Unite Us tech would be especially useful for accountable care organizations (ACOs) and value-based clinics because of the data it provides and its ability to tie to payments in a performance-based way.
Medical Economics: Top administrative challenges of 2023: Quality metric reporting (12/26) – Quality metric reporting can be a significant challenge to health care administration due to a number of obstacles. First and foremost, you need buy-in from the physicians providing the care to the patients. Without this, it is difficult to make any meaningful changes to the pattern of care provided. Second, it requires having a very robust quality and data analytics team in your health care system. The startup costs for this can be very high, and it may not always be easy to quantify the direct reimbursement seen from this. “Despite these challenges, quality metric reporting can be a useful tool for improving quality and value in health care,” Leah Alexander, M.D., a pediatrician at PediatriCare Associates in Fair Lawn, New Jersey says. “To overcome the challenges, it is important to work with an experienced partner who can help you collect accurate data and interpret (these data) in a way that will improve patient care.”
Forbes: What Is Value Based Care, And Why Is The Healthcare Industry Suddenly So Interested In It? (12/25) – Value-based care has become an increasingly popular buzzword, ensnaring much of the attention and press with regards to “the future of health care.” However, there is still a significant amount of work left to be done with regards to the infrastructure to support value-based care. This model requires significant resources, including administrators, specialists, and primary care experts, in addition to significant buy-in from allied health professionals. Furthermore, this will only be effective if regulators, policy leaders, and executives can convince the masses that value-based care is even worth pursuing, especially as FFS pundits continue to emphasize its demerits, accordingly.
RevCycle Intelligence: HHS Releases Ownership Data on All Medicare-Certified Hospitals (12/21) – HHS is releasing ownership data on all Medicare-certified hospitals in a bid to promote competition in a highly consolidated industry. The federal department also said the information could be used to analyze data and trends on how market consolidation impacts consumers with increased costs, without necessarily improving quality of care, and to evaluate the relationships between ownership and changes in health care costs and outcomes. HHS also plans to analyze the data to inform policy approaches that promote competition in health care.
Fierce Healthcare: 2023 forecast: Providers embrace start of new requirements on health equity (12/21) – Next year will be the start of a new payment model that calls for not just the collection of health equity data to determine social risk factors, but also the implementation of solutions to address these problems. Providers that have been working on equity for years are lauding the decisions to move beyond planning and collecting data and into action. The ACO REACH payment model contains the first of such requirements. “The equity plan is nice and all, but we’ve had lots of people ask for plans over the years,” said Travis Broome, senior vice president for policy and economics for Aledade. “What REACH did is they put equity straight down to the bottom line.”
Becker's Hospital Review: Hospital consolidation continues: 12 M&As that grabbed headlines in 2022 (12/21) – Consolidation continued to take flight across the health care sector this year, with many hospitals and health systems pursuing mergers and acquisitions to scale and reduce costs, provide additional care services and strengthen their footprint in certain markets. Here are 12 key transactions that were announced or have been completed this year.