Administrative Updates

CMS: (10/9) – CMS released the Trends in Subsidized and Unsubsidized Enrollment Report, finding that from 2016 to 2019, unsubsidized enrollment declined by 2.8 million people, representing a 45 percent drop nationally.

CMS: (10/8) – CMS recently announced new repayment terms for Medicare loans made to providers during COVID-19. CMS expanded the Accelerated and Advance Payment (AAP) Program on March 28, 2020 to help healthcare providers and suppliers combat the financial burden of the pandemic. The letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. Fact sheet FAQs

Legislative Updates

Congressional Letter to CMS: (10/9) – Reps. Axne (D-IA) and Fitzpatrick (D-PA) led a letter with 32 Representatives to CMS Administrator Verma urging the agency to expand Medicare telehealth coverage of valuable audiology and speech-language pathology during the COVID-19 pandemic.

Member News

Revcycle Intelligence: (10/13) – Comments on the proposed 2021 Medicare Physician Fee Schedule proposed rule centered on potential payment cuts, telehealth reimbursement, and quality reporting changes. The article includes MGMA’s comments on reconsidering quality reporting changes, which urges CMS to postpone significant changes to quality reporting during the pandemic.

Modern Healthcare: (10/10) – Travis Broome, Senior Vice President for Policy and Economics at Aledade discussed the Direct Contracting Program and how it solves the issue in the Medicare Shared Savings Program (MSSP) that if participants didn’t have an established patient base, they could not be an ACO. Direct Contracting Program participants will be called direct contracting entities instead. Broome also highlights that the Direct Contracting Program favors new entrants over existing ACOs, as the direct contracting financial terms may not be as rewarding for ACOs that have done well in the MSSP or NextGen ACO Programs. 

Healthcare Finance: (10/7) – MGMA released the Benchmarking for Patient Access in a Post-COVID-19 World report to provide guidance and insights for medical practice administrators and physician leaders as they work their way back to pre-COVID-19 levels of appointment availability and volume.

News Clips

Patient Engagement HIT: (10/13 ) – A new analysis of telehealth in primary care in JAMA reported that the insurgence of telehealth as a key primary care modality has changed the scope of primary care, as wellness checks, like those that track cardiovascular disease risk, are not normally conducted via telehealth. However, the researchers also noted that while telehealth may fill in some of these gaps in care, primary care visits in the first two quarters of 2020 had a stark decrease in assessments for cardiovascular disease risk factors, with a 50 percent decline in blood pressure assessments and a 37 percent drop in cholesterol assessment during quarter two of 2020 compared to the same quarter in previous years.

Washington Post: (10/12) – In the Washington Post Live’s recent episode on primary care in the time of COVID-19, Dr. Mike Varshavski, a primary care physician, and Dr. Patrice Harris, the past president of the AMA discussed how COVID-19 has changed primary care practice workflows, including using telehealth and placed pressure on primary care providers, leading to increased burnout.

Health Affairs: (10/9) – The COVID-19 pandemic has highlighted several inequities within the health care system. While Congress has provided financial support to providers during the pandemic to make up for lost revenue, there is an opportunity to target funding toward providers facing the greatest unanticipated costs and to support financially weaker providers to create a more efficient, equitable system.

Pediatric Annals: (10/9) – Mental health screening is a recommended process within pediatric primary care, but implementing an effective screening program can be challenging. This article outlines barriers to screening in pediatric settings, tools that can be incorporated into practice, and strategies for implementing accurate screenings within pediatric primary care.

AJMC: (10/9) – This study evaluated the association between regional market factors and experience with patient-provider communication in primary care services of safety net hospitals. The findings suggest that safety net hospitals could be unfairly penalized by value-based payment programs and Medical Hospital Compare, with the proposal that policies and programs should improve resource allocation by accounting for regional market factors before acting on quality of care measures.

Health Affairs: (10/8) – COVID-19 has resulted in a significant drop in elective health services between the months of February and July. If patient demand for elective services continues to be weak following the availability of a vaccine, independent providers will not have many options for recouping lost revenue, with small physician practices likely facing an especially high financial risk.

Medical Economics: (10/8) – A survey of 225 ACOs at the beginning of the pandemic revealed that 80 percent were “very concerned” about financial performance in 2020. A recent report by the Commonwealth Fund found that ACO providers have faced cumulative deficits in both practice revenues and patient visits, with many providers still reporting the number of office visits remaining under 10 percent below pre-pandemic levels, with many patients still delaying care.

Business Wire: (10/7) – Humana released its annual Value-based Care Report on October 7. Compared to beneficiaries in a FFS model, Medicare Advantage beneficiaries receiving care from primary care physicians in a value-based payment model experienced better health outcomes, more preventive care, and lower costs, saving an estimated $4 billion in reduced costs through value-based care.

Medical Economics: (10/7) – COVID-19 has emphasized the need for providers to diversify by augmenting FFS with value-based care revenue streams. Providers that stay in VBC contracts but opt out of the risk associated with COVID-19 patients will likely fare better than those who did not.

Healthcare Dive: (10/7) – According to a new report, COVID-19 may be speeding up mergers and acquisitions (M&A), meaning that the COVID-19 pandemic has not produced a dramatic decline in deals. The third quarter had 19 transactions announced, increasing from 14 transactions in the second quarter. Financial pressures may cause struggling hospitals to turn to M&A and will strengthen the need for partnerships moving forward.

Events

October

• October 14, California Medical Association, “Telehealth Series for Small and Medium Sized Practices: Selecting the Right Telehealth Platform for Your Practice.” Virtual.
• October 19-21, MGMA, “Medical Practice Excellence Conference.” Virtual.
• October 21, Primary Care Collaborative, “Making the Call on the Best Use of Telehealth in Primary Care.” Virtual

November

• November 30-December 1, Primary Care Collaborative, “Crisis As Catalyst: Reimagining Primary Care.” Virtual Annual Conference.

If you would like your event to be included in the next newsletter, please email kristen@physiciansforvalue.org.